Perioperative Analgesia for Foot and Ankle Surgery: A Comprehensive Review

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Postoperative pain following foot and ankle surgery can impede patient recovery and mobilization.
• Effective perioperative analgesia is vital for optimizing surgical outcomes, minimizing opioid consumption, and facilitating early discharge.

Purpose of the Study:

• To provide an updated review of regional anesthesia techniques for foot and ankle surgery.
• To highlight the role of anatomical considerations, ultrasound guidance, and patient-tailored block selection.
• To discuss various neuraxial and nerve block techniques, including the Mayo block, intravenous regional anesthesia (Bier block), and the WALANT approach.

Main Methods:

• Review of current literature on regional anesthesia for foot and ankle procedures.
• Emphasis on ultrasound-guided techniques versus landmark-based methods.
• Discussion of multimodal analgesia strategies incorporating regional blocks, non-opioid medications, and adjuvants like dexamethasone.

Main Results:

• Ultrasound guidance significantly enhances the precision and safety of regional blocks.
• Multimodal analgesia effectively controls pain while reducing opioid requirements.
• Motor-sparing techniques and short-acting spinal agents are beneficial for ambulatory foot and ankle surgery, supporting rapid recovery and same-day discharge.

Conclusions:

• Integrating anatomical knowledge with ultrasound guidance and multimodal pain management strategies allows for tailored perioperative pain control.
• Optimized pain management balances effective analgesia with early patient mobilization and safety.
• Regional anesthesia is a cornerstone for improving patient outcomes in foot and ankle surgery.