Single-injection applications for foot and ankle surgery

Foot or ankle surgery is often performed in an ambulatory care setting. The post-operative pain that follows can be moderate to severe in intensity and difficult to control with oral analgesics. Regional anaesthetic techniques have been advocated for such procedures. Wound infiltration with long-acting local anaesthetic provides post-operative pain relief which, though efficient, lasts for too short a time. Intravenous regional anaesthesia (IVRA) is a safe anaesthetic technique for minor surgery of short duration. It is not indicated for painful and/or complex procedures. Ankle block is convenient for most procedures but is somewhat less reliable than popliteal sciatic nerve block. Associated with a saphenous or femoral nerve block, posterior popliteal sciatic nerve block is the technique of choice. Patients can be safely discharged even when long-acting local anaesthetics are used. In major surgery a continuous technique can be proposed. When the prone position is impossible the lateral approach is an efficient alternative.