Postoperative Sciatic Neuropathy Following Ankle Surgery and Peripheral Nerve Blockade: A Case-Based Review

Peripheral nerve blocks are commonly used for intraoperative and postoperative analgesia in foot and ankle surgery due to superior pain control and opioid-sparing effects. Although considered safe, neurologic complications can occur and present diagnostic and management challenges for the anesthesiologist. This case-based educational review describes a 72-year-old patient who developed persistent postoperative sciatic-distribution motor and sensory deficits after ankle open reduction and internal fixation performed with adductor canal and popliteal sciatic nerve blocks. The clinical scenario highlights the difficulty of determining causation when neurologic deficits arise in the setting of regional anesthesia, surgery, tourniquet use, and patient-specific risk factors. Through this clinical scenario, key perioperative considerations are reviewed, including risk factors for nerve injury, recognition of abnormal block recovery, diagnostic evaluation, and evidence-based management strategies. This structured case discussion is designed for anesthesiology trainees and perioperative clinicians to support safe regional anesthesia practice and early identification of neurologic complications.