The Journal of Bone and Joint Surgery (American). 2008;90:1443-1446.
doi:10.2106/JBJS.G.01133
© 2008 The Journal of Bone and Joint Surgery, Inc.
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The Efficacy of Combined Popliteal and Ankle Blocks in Forefoot Surgery

Rohit Samuel, BSc(Hons), MBChB, MSc, FRCS(Orth)1, Andrew Sloan, MBChB2, Kuntal Patel, MS(Orth), MRCS(Ed), DipSEM(GB&I)3, Magdy Aglan, MBBch, MSc, FFARCSI, FRCA4 and Aamir Zubairy, MBBS, FRCSI, FRCS(Orth)4

1 67 Heaton Road, Stockport SK4 4JJ, United Kingdom. E-mail address: rohitsamuel{at}hotmail.com
2 18 Yewlands Avenue, Fulwood, Preston PR2 9QR, United Kingdom
3 10 The Pennines, Fulwood, Preston PR2 9GB, United Kingdom
4 Departments of Anaesthetics (M.A.) and Orthopaedic Surgery (A.Z.), Burnley General Hospital, Casterton Avenue, Burnley BB10 2PQ, United Kingdom
Investigation performed at the Department of Orthopaedic Surgery, Burnley General Hospital, Burnley, United Kingdom

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Postoperative pain following forefoot surgery can be difficult to control with oral analgesia. The aim of this study was to compare the efficacy of a combined popliteal and ankle block with that of an ankle block alone in providing postoperative analgesia following forefoot surgery.

Methods: We performed a prospective, randomized, controlled single-blind study involving sixty-three patients, twenty-six of whom had a combined ankle and popliteal block and thirty-seven of whom had an ankle block alone. All patients underwent an elective osseous surgical procedure on the forefoot. Postoperative pain was evaluated with use of a visual analogue scale and a verbal response form. Patient satisfaction was also recorded.

Results: The patients who had had a combined popliteal and ankle block had significantly less pain at six hours postoperatively (p = 0.011), twenty-four hours postoperatively (p < 0.001), and at discharge (p = 0.014). This group of patients also had higher satisfaction with pain relief.

Conclusions: A popliteal block in conjunction with an ankle block provides significantly better pain relief than does an ankle block alone in patients undergoing forefoot surgery.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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Combined popliteal and ankle block - is it really necessary?
Simon S. Jameson, et al.
JBJS Online, 21 Jul 2008 [Full text]
Drs. Samuel and Zubairy respond to Mr. Jameson and Mr. Kumar
Rohit Samuel, et al.
JBJS Online, 29 Sep 2008 [Full text]