Lower Extremity Nerve Blocks for Outpatient Foot and Ankle Surgery:
A Literature Review
Tony Tsai, MD, Takashige Iwata, MD, Shruti Shah, MD, Richard E Claudio, BS, Admir Hadzic, MD, PhD
Department of Anesthesiology, St. Luke’s-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY

Introduction: Foot and ankle surgeries are common outpatient procedures resulting in significant postoperative pain which may require large doses of opioids and interfere with early mobilization and discharge of patients home. Local, spinal, epidural, and general anesthesia have been used with success for foot and ankle surgeries. An ideal anesthetic should result in adequate surgical operative conditions, high operating room efficiency, few side effects, rapid recovery, and high patient satisfaction. We undertook a systematic review of the literature on this topic to see whether the use of peripheral nerve blockade (PNBs) has any advantages over local, neuraxial or general anesthesia for this indication.
Methods: The relevant clinical literature search for this review was conducted using MEDLINE and OVID. Specific key words that were searched include “foot and ankle surgery”, “spinal anesthesia”, “epidural anesthesia”, “peripheral nerve blockade”, “popliteal fossa nerve block”, “sciatic nerve block”, “regional versus general anesthesia”, “neuraxial anesthesia”, “local infiltration”, and “perioperative outcomes.” In the search and selection process, we deemphasized intuition, unsystematic clinical experience, and physiologic parameters. However, when clinical trials were unavailable, we chose observational studies, systematic clinical observation, and pathophysiological reasoning.
Results: Twelve clinical trials were reviewed with sample size ranging from 30 to 3804 patients. Table 1 shows a comparison of various anesthetic techniques along with perioperative outcomes in foot and ankle surgery. Success rates of PNBs ranged from 79-97%. Patient satisfaction and acceptance were high for all PNB techniques and less opioids were required for postoperative pain management.

Legend: PSNB=Popliteal Sciatic Nerve Block; FAS=Foot and Ankle Surgery; SNB=Sciatic Nerve Block; FNB=Femoral Nerve Block; SA=Spinal Anesthesia; SFNB=Sciatic Femoral Nerve Block; GA=General Anesthesia; AB=Ankle Block; PNB=Peripheral Nerve Block; SVT=Supraventricular Tachycardia
Conclusion: The findings of our comprehensive literature search indicate that PNBs are an excellent alternative for foot and ankle surgery. When compared to other anesthetic techniques, such as general, epidural, and spinal anesthesia, PNB provides reliable anesthesia, high patient satisfaction, superior postoperative analgesia, and opioid sparing effects. In addition, PNBs result in less urinary retention and longer postoperative analgesia. The benefits of PNBs can be extended by utilizing a continuous perineural
infusion after discharge home.

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