Evaluation of 350 sciatic blocks in rheumatoid foot surgery

Area of Science:

• Anesthesiology
• Rheumatology
• Surgical Procedures

Background:

• Rheumatoid arthritis patients often require surgical interventions like the Keller/Clayton operation.
• Effective regional anesthesia is crucial for managing pain and improving outcomes in these patients.
• Sciatic nerve blocks are a common anesthetic technique for lower limb surgeries.

Purpose of the Study:

• To evaluate the efficacy of Mepivacaine sciatic nerve blocks in rheumatoid patients undergoing the Keller/Clayton operation.
• To assess the need for supplementary anesthesia techniques in cases of insufficient sciatic block.
• To observe the effects of concomitant sympathetic block on physiological parameters.

Main Methods:

• A sciatic nerve block using Mepivacaine (3-4 mg/kg) was administered to 340 rheumatoid patients.
• Insufficient blocks were supplemented with femoral nerve blocks, re-blocking the sciatic nerve, or local anesthetics.
• Spinal anesthesia was used as a rescue anesthetic in a few cases.
• Sympathetic block effects on sweating and skin temperature were monitored.

Main Results:

• Sciatic block with Mepivacaine achieved successful anesthesia in 91.9% of patients.
• Supplementary anesthesia techniques were required in 8.1% of cases, providing adequate operating conditions.
• Three patients required additional spinal anesthesia.
• Concomitant sympathetic block resulted in immediate cessation of sweating and prolonged skin temperature changes.

Conclusions:

• Mepivacaine sciatic nerve block is a highly effective anesthetic for rheumatoid patients undergoing Keller/Clayton surgery.
• Supplementary anesthesia techniques are valuable for managing insufficient sciatic blocks.
• The sympathetic block component offers additional benefits like altered sweating and skin temperature regulation.