Block It Like It’s Hot: Regional Anesthesia, Pain Medicine & POCUS S3 E15: "Plenty of sole, and lots of kick: Blocks for foot and ankle surgery"
Sep 30, 2025
Explore the intricacies of foot and ankle anesthesia! Discover a range of blocks, from digital to popliteal sciatic. Learn about pain expectations for various surgeries like bunions and fractures. Listen to insights on ultrasound techniques and the advantages of nerve stimulation. Dive into the humorously shared experiences of the hosts, while debating tourniquet pain management and local infiltration strategies. Plus, hear about innovative methods like WALANT for awake surgeries and the use of liposomal bupivacaine for lasting relief!
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Match Block To Surgical Location
- If surgery is midfoot or distal, use an ankle block; for ankle, hindfoot or proximal surgery, prefer popliteal sciatic plus saphenous.
- Always confirm planned tourniquet location first because a thigh tourniquet may mandate GA or spinal instead.
Plan For Tourniquet Pain
- Manage tourniquet pain proactively: use light propofol sedation and consider a Femoral Arterial Block (FAB) when needed.
- Discuss with the surgeon alternatives like calf tourniquets to reduce intolerable thigh cuff pain under sedation.
Ultrasound Plus Stimulator For Difficult Cases
- Use ultrasound for most popliteal and ankle-region blocks but keep nerve stimulation as an adjunct in difficult patients.
- Ultrasound raised success rates and reduces blind failures in obese or hard-to-image patients.