Home Ambulation after Long Acting Peripheral Nerve Block for Lower Extremity
Ambulatory Surgery
Jean-Louis Horn, Ryan C Goldsmith
Department of Anesthesiology and Perioperative Medcicine
OHSU, Portland Oregon

Introduction:
Little data exists about the safe use of long acting local anesthetic for lower extremity blocks in the outpatient setting. In the past it was recommended to wait for full recovery from peripheral nerve block to discharge patients home. Recently continuous peripheral nerve blocks have been used for the management of post-operative pain after out patient surgery with minimal complication and high quality of care.(1,2) Chelly has warned that a patient with an anesthetized lower extremity may experience difficulties to ambulate and fall.(3) At our institution we have used long action local anesthetics for lower extremity
ambulatory surgery. Many patients went home with an anesthetized or partially anesthetized leg. In this study we looked in details at block efficacy, sleep pattern, pain control and ability to ambulate after peripheral nerve block of the lower extremity for ambulatory surgery.
Methods:
Our Institutional Review Board approved this study. We conducted a retrospective survey of patients that received lower extremity peripheral nerve block(s) with long acting local anesthetics (bupivacaine or ropivacaine) and were sent home before the block wore off. Patients were selected if they were given a sciatic, a lumbar plexus or a femoral block alone or a combination of a sciatic block with either lumbar plexus or femoral block. Ankle blocks and local anesthesia were excluded from the survey. Patient charts were reviewed first. Then each patient was contacted by phone and asked to rate the effectiveness of their block and how long the block lasted. Each patient was questioned about their ability to ambulate before and after their block wore off and their sleep pattern after surgery. Finally, patients were asked to rate the effectiveness of their pain control while their leg was anesthetized and after the block wore off.
Results:
From December 2002 to December 2004, 244 patients were identified and 32 patients were successfully contacted. Ages ranged from 18 – 81 with a mean of 39 with 20 males and 12 females. Nine patients received a combined lumbar plexus-sciatic block, 5 received a combined femoral-sciatic block, 3 received a lumbar plexus block, 10 received a femoral block and 5 received a sciatic block. Block efficacy (on a scale from 1 to 5, 5 being the most effective) was very high with a median of 5. Two patients had a score of 1 and 1 patient had a score of 3. Four patients had a block lasting less than 8 hours, 6 had a block lasting more than 12 hrs. Thirty-one patients had no trouble ambulating at home with an effective long lasting peripheral nerve block. One patient had trouble getting around with the leg blocked but his ambulation did not improve after the block wore off. There was no incidence of falls and only one near fall. This near fall was from the patient’s verconfidence of getting around without crutches and being cocky after an ACL repair. No patients had trouble urinating with an anesthetized leg. Four patients had no disturbance in sleep
the night after surgery. The remaining, 28 patients experienced sleep disturbance after surgery. Four patients were unable to use their prescription pills due to nausea after the block wore off. After the block wore off only 11 patients were able to control the pain adequately.
Discussion:
Patient satisfaction was high with peripheral nerve block. Blocks were efficacious and provided good postoperative pain control with no important interference with ambulation. In fact several patients commented that ambulation was more impaired after the block wore off due to poor pain control. This study indicates that long lasting peripheral nerve blocks are safe and desirable for ambulatory lower extremity surgery.
References:
1. Klein SM et al. Anesthesia & Analgesia. 94(1):65-70, 2002
2. Ilfeld BM et al. Anesthesiology. 97(4):959-65, 2002
3. Chelly JE et al. Regional Anesthesia & Pain Medicine. 29(1):1-3, 2004

TOP

© SOCIETY FOR AMBULATORY ANESTHESIA
520 N. Northwest Highway Park Ridge, Illinois 60068-2573
Tel: (847) 825-5586 Fax: (847) 825-5658
E-mail: samba@asahq.org