Abstract

NM-290

Regional Blocks and Foot Surgery

Falcinelli J, Greene N, Ross A
Duke University Health Systems, Durham, NC, USA

Intro
Children with foot deformities who have pain that affects normal activities may require surgical osteotomies. We reviewed charts to determine what type of regional block would improve postoperative pain management.

Methods
A retrospective review identified patients under age 18 years having calcaneal osteotomy between July 2013 and June 2017. Data included age, weight, type of block, local anesthetic, and pain scores on postop day 0 and postop day 1.

Results
A total of 125 patients had calcaneal osteotomy surgery. Table 1. All blocks used ropivacaine between 0.2 and 0.5%.
On postop day 0, patients with blocks had lower pain scores than patients with no block. Figure 1. On postop day 1, patients without nerve blocks had similar pain scores to those with nerve blocks with a linear decrease in pain scores as peripheral nerve block intervention increased.

Discussion
Orthopedic procedures performed on unilateral extremities allow for peripheral nerve blockade. Our results showed that pain scores on postoperative day 0 were better in all of the peripheral nerve block groups compared to the group who had no blocks performed perhaps due to the nature of local anesthetics and duration of action. On postoperative day 1, pain scores increased from postop day 0 in those patients who had single shot procedures as well as those who had catheters perhaps due to a portion of catheters not being in the proper position or having been removed early. There was however a linear decrease in pain scores from single shots to single catheters to double catheters. Improved pain scores from postop day 0 to postop day 1 was observed in the group where no block had been performed perhaps due to successful titration of oral narcotics.
Limitations of this study include its retrospective nature. There is a possibility that a procedure may be less or more invasive than posted or may not include need for saphenous. Other limitations include lack of data for outpatients.

Conclusion
In a retrospective chart review of pediatric foot surgery, peripheral nerve blocks and catheters improved postoperative pain scores on day 0 over having no peripheral block. Placement of catheters for foot surgery may extend this improvement in postoperative pain into the first postoperative day.

Bouchard. J Am Acad Orthop Surg 2014 Oct; 22(10): 623-32.
Shah. Br J Anaesth 2013; 111: i114-i124.
Ganesh. Anesth Analg 2007; 105: 1234-42
Ilfeld. Anesth Clin 2011; 29:193-211
Gurnaney. Anesth Analg 2014; 118:621-627