Thursday, November 30, 2023

Nerve Block For Ankle Surgery

More Specific Side Effects To Be Aware Of:

Nerve Block of the Ankle Region for Regional Anaesthesia of the Foot

For injection of nerve behind your knee or further up your leg: Your leg will become numb and the power to move it is also affected. You will not be able to reliably balance without the assistance of crutches or a stick. The physiotherapists will assess your safety and provide you with an appropriate aid. For many of the operations for which the block is useful, you will not be weight-bearing for a period afterwards to help healing. A block should not compromise the speed of return to the normal mobilisation which aids recovery. These sensory and motor symptoms usually get better as the block wears off. In rare cases, weakness of the foot affecting your ability to walk and/or numbness can last for a prolonged period or be permanent. .

Very rare: life-threatening reactions such as a fit or seizure in reaction to the local anaesthetic are very rare. These require emergency treatments. Your anaesthetist can discuss these with you if you wish to know more.

Nerve injury: nerves can be damaged during surgery, general anaesthetic or a block. It is estimated to happen between 1 in 700 to 1 in 5000 cases where a block is performed. There may be a long lasting numbness patch or tingling after the operation. Uncommonly, there may be weakness in one or more muscles and persistent pain.

Is A Nerve Block Safe

Like general anesthesia, nerve blocks involve some side effects and risks. Most common side effects include unpleasant numbness and weakness of the muscle, when catheters are placed a little bit of leak can occur around the catheter entry and that is totally normal. It is also normal to experience some pain after surgery despite the block. As the block wears off, pain usually increases and it is important to take oral medications early to help control it. Serious complications are very rare and include large bruise or infection at the block area and persistent nerve symptoms and those are usually temporary.

Peripheral Nerve Block For Foot And Ankle Surgery

At Parkside Orthopaedics and Sports Medicine Centre, our expert team perform foot and ankle surgery in four modern operating theatres. In many cases, we can offer you an injection called a peripheral nerve block. This gives you temporary pain relief during and after an operation.

What is a peripheral nerve block?

The peripheral nerves are the nerves outside your brain and spinal cord. They send information between your brain and the rest of your body.

A peripheral nerve block involves injecting a numbing medicine called a local anaesthetic and other painkillers near the main nerves to your leg. This temporarily blocks the nerves from sending pain messages to the brain. Pain can be blocked for up to 18 hours.

Why might I need a peripheral nerve block?

We often use a peripheral nerve block during foot and ankle surgery. A specialist anaesthetist gives you an injection to make your foot and ankle numb for a temporary period. The injection stops you from feeling any pain during the operation and gives you extra pain relief afterwards.

You may have the injection in the foot or ankle, behind the knee or thigh or near the groin. This depends on what operation you have. Two types of peripheral nerve blocks commonly used in foot and ankle surgery are:

  • Ankle block: You have an injection around your ankle to make your foot numb.
  • Popliteal nerve block: You have an injection at the back of your knee to make your lower leg, foot and ankle numb.

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How Are Blocks Performed

You should prepare for your operation by following the instructions from pre-operative assessment clinic. This includes following the fasting advice.

The nerve block is usually performed in the anaesthetic room. Your heart rate, blood pressure and breathing will be monitored and a cannula placed into a vein before the block. Most blocks are performed awake before your general anaesthetic.

Depending on where the block injection is, an assistant will help you to get into the correct position. This may involve turning over to lie on your front or side. Some blocks may be done when you are under general anaesthetic your anaesthetist will discuss this with you on the day.

The skin will be cleaned and the area numbed before the injection. The nerves are located using an ultrasound machine or a very small machine that makes your leg muscles twitch. A very fine block needle is used to give the local anaesthetic to block the nerves.

For most patients, the injection is no more painful than having the cannula in your vein or bloods taken. Once the injection is done, your leg or foot may start to feel warm, tingly or numb but it can take 20 to 40 minutes for the block to work fully.

Ankle Surgery And Nerve Blocks

Peripheral Nerve Blocks in Foot and Ankle Surgery


I am currently in hospital having broken and dislocated my right ankle badly on Saturday.

I had a nerve block ahead of the surgery to reduce and then fix my fractures. I am now lying here terrified as my toes feel numb and I can’t move them the pulse in my foot is perfect I am told . I have spoken to the nurses and they say I need not worry but I cant stop my anxiety.

Have any of you had nerve blocks and can you tell me how long they lasted before wearing off?

I am so scared.

  • 10 months ago

    Hello ,

    I had my surgery on 15th April and I opted for nerve block. It is pretty convenient as it makes you feel no pain at all. 80% of the patients will go for it. It took 36 hours for the nerve block to wear off but the pain after the nerve block wore off was extremely painful. I called the doctor’s office 20 times as it is the weekend and there was no one to help. I suggest you get some Dualadid ready to manage this pain as it made me cry. I usually can tolerate pain and it was un-tolerable. The numbness in your leg is normal as I still feel numb in my toes after 4 weeks. It eventually get better is what I was told.

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Do I Have The Right To Refuse The Block

Yes. We will tell you about your options and you will decide what is best for yourself. We will advise you to have surgery with a nerve block if we think it provides the best anesthetic conditions with the least side effects. In some rare situations, general anesthesia may be riskier compared to having surgery with a nerve block. In these specific cases, we would strongly advise you to have a nerve block for surgery. Often we combine the nerve block with general anesthesia to decreases side effects and improve the recovery of general anesthesia.

What Is A Nerve Block

Nerve block, also known as regional anaesthetic, is an injection of local anaesthetic by your anaesthetist to block the nerve or a group of nerves that supply the area of your body where your operation will be.

How is a nerve block used?

Nerve blocks for leg, foot and ankle surgery can be made to last up to 24 hours. The nerve block may be part of your general anaesthetic to give you pain relief after your operation.

Some operations can be done under nerve blocks alone. Sedation can be given with this to make you feel relaxed and comfortable.

Certain drugs or medical conditions may make blocks unsuitable for you. Your anaesthetist will discuss these with you on the day of your operation.

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Complications And How To Avoid Them

Because most surgery is done under tourniquet, it is difficult to differentiate the cause of neurologic complications. In a retrospective study of 3027 patients with pneumatic ankle tourniquet at relatively high pressures of 325 mmHg, there were three cases of posttourniquet syndrome. Ankle tourniquets have been used routinely with as little as 200 mmHg pressure, although a bloodless surgical field may require 218.6 ± 34.6 mmHg, with younger normotensive patients requiring only 203.9 ± 22.3 mmHg. Thus, no more than 250 mm Hg pressure is necessary, and more pressure may be harmful.

Local anesthetic systemic toxicity would be expected to be rare, given the low blood levels after injection. In the retrospective series of 1373 patients previously mentioned, 1 patient had a convulsion, thought to be secondary to an intravascular injection. In another series of 1295 patients who received standard and modified ankle blocks as well as digital nerve blocks, 3 patients had vasovagal reactions and 1 had an episode of hypotension and supraventricular tachycardia, thought by the investigators to be from lidocaine toxicity. No other complications were seen in this series.

There are single case reports of injection-related complications such as an Achilles tendon avulsion from tibial nerve block in a patient with spastic talipes equinovarus, and acute compartment syndrome from ankle block in a patient with previous scarring from forefoot arthroplasty.

Why Should I Have A Nerve Block

Common Peroneal Nerve Block

A nerve block decreases your pain during and after surgery. It is more effective than pain medications through the IV. Because you have less pain, you will need less oral or IV pain medications, even though you will have the medications available to you. You will have fewer side effects of pain medications, such as respiratory depression, itching, nausea, and somnolence. In addition, you may be able to avoid a general anesthesia. Sometimes, a nerve block is done in addition to a general anesthesia for pain relief after the surgery.

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What Are The Risks And Side Effects Of Having A Block

Block injections are generally very safe but there are still risks to be aware of. Common side effects including bruising or discomfort around the injection site are usually short-lived.

These symptoms go away within 4 to 6 weeks in most cases and within a year in majority . Swelling after the operation, or conditions such as diabetes can make nerve damage more likely.

Are There Different Types Of Nerve Blocks

An anesthesiologist will choose a type of the nerve block based on several factors, including your general health and the surgical procedure you are about to undergo. In many cases, your doctor may administer a single shot of medication that will provide pain relief throughout the surgery and often for a few hours afterwards.

Depending on the site of the surgery, there are also epidural blocks, that are often used to control pain during labor, and spinal blocks, which involve injecting anesthetic medication near the spinal canal. For some patients, the anesthesiologist may recommend using a combination of drugs and techniques that can include a nerve block, general anesthesiaand, in some cases, a small amount of opioid medicationto provide the most effective relief in a particular situation.

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What Are The Risks Of Nerve Blocks

Like anything else, there are risksalthough rareassociated with nerve blocks. They might include bleeding, soreness or infection at the site of the injection.

Nerve injury is rare. If it happens, it is temporary in most cases, and very rarely becomes permanent. In general, the rate of nerve injury is low, varying with the type of nerve blockade and surgery. As with any type of anesthesia or surgery, if you experience any feelings that seem unusual, you should tell your anesthesiologist right away.

Are There Any Risks To Me


You should discuss these with your anaesthetist. Some of the risks with a nerve block are:

  • Nerve damage. This may be result in tingling, numbness or weakness. It is uncommon, but if it does occur, may last several weeks before getting better. Very occasionally it may be permanent.
  • Bruising or bleeding around the injection site
  • The nerve block may not completely remove pain and you may still need some other pain killing drugs
  • Local anaesthetic drugs can cause heart problems or loss of consciousness if accidentally injected into a blood vessel

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What Are The Benefits Of Having A Nerve Block

These include:

Better pain relief. You are less likely to need strong pain killers after your operation, avoiding their side effects like nausea or sleepiness and confusion.

If your operation can be done under a block alone, you can avoid the risks and side effects of a general anaesthetic.

You are more likely to go home on the same day after your operation if your pain is well-controlled after a block.

Common Peroneal Nerve Block

Occasionally local infection or trauma preclude blockade of the deep and superficial peroneal nerves around the ankle. The option is to block the common peroneal nerve more proximally at the level of the knee. This nerve is most easily identified postero-lateral to the fibular neck where it lies adjacent to the bone. The end-point when using the stimulator is dorsiflexion and eversion of the foot and the nerve can be successfully blocked by this approach with as little as 5 ml of bupivacaine 0.5%.

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What If Things Become Worse After Initial Surgery

While the intent of surgery following an ankle sprain or fracture is to improve the situation, there is always a possibility of a complication that makes matters worse. Perhaps the nerve is trapped within scar tissue, or nerves do not respond to decompression.

In some situations, a nerve that was cut as part of a past surgery may develop painful growths called neuromas. There is always the possibility this may happen during a procedure we conduct as well.

In the cases of nerve removal or release from scar tissue, patients may occasionally experience more hypersensitivity and burning. Greater care will be necessary during recovery and post-op physical therapy may be longer, which may affect a return to activities. Everything must pass the commonsense test.

We will extensively review any potential complications from an initial surgery and discuss with you whether further action may be recommended. This may include dealing with neuromas, or revision or full removal of a nerve.

If a nerve is removed, an area of numbness is typically experienced. This will usually shrink over time following the surgery, but almost never fully comes back. A patient should expect permanent numbness to a small degree, but it is often greatly preferred over the pain.

What Are The Benefits Of Nerve Blocks

Sural nerve block ankle

Nerve blocks have proven to be more effective at controlling pain than medications delivered through an intravenous or intramuscular , which involves injecting medication into a vein or muscle. Because a nerve block controls acute pain so well, patients tend to need less pain medication in the hospital and at home after surgery.

Another advantage of a nerve block is that, for selected procedures, it can help you avoid general anesthesia, which has side effects that can range from nausea and vomiting to temporary confusion.

Since there is no need to recover from a nerve blockand there typically will be less pain lateryou can begin to eat and drink earlier, and participate in physical therapy faster after surgery, which is associated with faster healing and better health outcomes. You can go home from the hospital sooner and start any physical therapy to heal fully.

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What Will The Nerve Block Feel Like

If your anesthesiologist gives you mild sedation, it may make you drowsy and relaxed. The nerve block injection itself should cause minimal pain, if any. Otherwise, for certain procedures such as hand surgery, you should be able to remain awake and aware of your surroundings and free to communicate with your caregivers during surgery, if desired. This is different from general anesthesia, which would make you unconscious, and could lead to some lingering confusion and cognitive dysfunction when you wake up, especially if you are an older adult.

Once your surgery is over, you may feel some heaviness or numbness from the nerve block. Its important to talk to your caregivers before you stand up and move aroundor put any pressure at all on your bodybecause the nerve block may continue to affect your muscle control and balance for a while.

Significance Of The Study

  • This study showed that ankle nerve block adjuvant to general anesthesia reduced postoperative pain and improved foot function after hallux valgus surgery during a 1-year period. If there is no allergy to the anesthetic or contraindication in patients who undergo hallux valgus surgery, ankle nerve block should be added to general anesthesia for providing better pain control and foot function.

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Inclusion Criteria And Study Selection

All studies that were eligible for our analysis met the PICOS criteria . Population: patients who had undergone outpatient foot and ankle surgery. Intervention: Using continuous popliteal sciatic nerve block as the pain control method. Comparator: Single-injection popliteal sciatic nerve block. Outcomes: Visual analog scale at different time points, amount of oral analgesics consumed, patient satisfaction and need of admission. Studies must have a follow-up rate of at least 80%, and at least 1 of the above outcome parameters was included. Study design: interventional randomized controlled trials.

Who Do I Contact If I Feel My Patient Could Benefit From A Regional Anesthesia Technique

Regional Anesthesia â Taming the SRU

When booking OR cases, surgeons can enter requests for regional anesthesia. The Department of Anesthesia schedules experienced providers to perform these blocks in all ORs. For regional anesthesia in inpatients reach out to the Acute Pain Service that covers your campus.

Please see the link for the pain team consult service:

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How Is A Nerve Block Administered

The anesthesiologist will perform a nerve block before you go into the operating room. Often, she will give you a mild sedative first to relieve any anxiety and help you relax. Next, she will insert a hair-thin needlethe size of an acupuncture needleand inject medication into the surgical site in an area around the nerve. The anesthesiologist will watch the progress of the needle on a monitor, using real-time ultrasound guidance to make sure the pain relief medication is delivered with precision.

With a nerve block, the idea is to only send medication around the nerve so that the nerve can absorb it. Its important to avoid making an injection directly into it, which can cause serious side effects including limb numbness or weakness. The anesthesiologist may choose from a variety of numbing medications, including lidocaine, which is also used as a numbing agent for dental procedures.

A nerve block typically takes less than 10 minutes to administer and up to 30 minutes to take full effect.

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