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

Area of Science:

• Anesthesiology
• Neurology
• Orthopedic Surgery

Background:

• Peripheral nerve blocks are widely used for analgesia in foot and ankle surgery, offering effective pain management and reducing opioid use.
• Despite their safety profile, neurologic complications following regional anesthesia can pose diagnostic and management challenges for clinicians.
• Determining the cause of neurologic deficits is complex, involving factors like regional anesthesia, surgical procedures, tourniquet application, and individual patient risks.

Purpose of the Study:

• To present a case-based educational review of persistent neurologic deficits after peripheral nerve blocks in foot and ankle surgery.
• To highlight the diagnostic difficulties in attributing nerve injury to regional anesthesia, surgery, or other perioperative factors.
• To review key considerations for safe regional anesthesia practice, including risk factors, recognizing abnormal recovery, and management strategies.

Main Methods:

• A case report of a 72-year-old patient experiencing persistent sciatic-distribution motor and sensory deficits post-ankle surgery is presented.
• The patient received adductor canal and popliteal sciatic nerve blocks for intraoperative and postoperative analgesia.
• A review of perioperative factors, risk assessment, and diagnostic approaches for neurologic complications is integrated with the case discussion.

Main Results:

• The case illustrates the challenge of diagnosing the etiology of neurologic deficits in the context of regional anesthesia and surgery.
• Persistent motor and sensory deficits in the sciatic nerve distribution were observed postoperatively.
• The review underscores the importance of a structured approach to identify and manage potential nerve injuries.

Conclusions:

• Persistent neurologic deficits after regional anesthesia require careful diagnostic evaluation to determine causation.
• Anesthesiology trainees and clinicians should be aware of risk factors and strategies for managing neurologic complications.
• Early recognition and evidence-based management are crucial for optimizing patient outcomes following regional anesthesia for foot and ankle procedures.