Differences in analgesia in opioid naïve and tolerant patients with sciatic nerve blockade following elective foot and ankle surgery

1.1 Introduction and Purpose: Adequate postoperative analgesia in the opioid tolerant with chronic non-malignant pain is challenging. Multimodal pain relief regimens include regional anesthesia but opioid tolerant patients report increased postoperative pain and opioid consumption. This study compared analgesia in opioid naïve and tolerant patients receiving postoperative sciatic nerve blockade for foot and ankle surgery. 1.2 Method: Preoperative pain scores, trauma, maintenance and intraoperative opioid doses and following postoperative sciatic nerve blockade, patient self-reported pain scores and opioid consumption at discharge from the post-anesthesia unit and 24 hours were recorded. 1.3 Results: 191 patients enrolled. 40.3% were opioid tolerant and 33% had lower extremity trauma. Preoperative, immediate and delayed postoperative pain scores and intraoperative, immediate and 24 hour postoperative consumption of opioids were increased in opioid tolerant patients. Trauma and continuous infusion in opioid naïve and tolerant groups did not result in differences in 24 hour opioid consumption. 1.4 Limitations: Small subgroups and use of the pain score limited the accuracy of results. 1.5 Conclusion: Opioid tolerant patients require greater analgesic doses following sciatic nerve blockade for foot and ankle surgery. 24 hour opioid consumption for opioid naïve and tolerant patients is neither influenced by lower extremity injury nor continuous infusion.

Prolonged Duration of Sciatic Nerve Blockade in the Elderly after Foot and Ankle Surgery

1.1 Background and Objectives: Perioperative morbidity related to anesthesia renders elderly patients vulnerable because age related factors affect medication effects, clearance and metabolism. Regional anesthesia within a multimodal regimen reduces opioid adverse effects in the elderly and improves immediate analgesia but not long term recovery and prolonged nerve blockade has been reported. The purpose of this study was to assess analgesic effects of sciatic nerve blockade in the elderly. 1.2 Methods: Postoperative sciatic nerve blockade was administered for foot and ankle surgery to patients over age 18 years. Preoperative, post-anesthesia unit and 24 hour postoperative pain scores and opioid doses for these same intervals were recorded. 1.3 Results: 47 patients enrolled and 12 (25.5%) were over age 70. Preoperative, immediate and 24 post-operative pain scores and total intraoperative and immediate postoperative opioid doses were lower in the elderly. The total 24 hour postoperative opioid doses in the elderly were lower compared to the younger group. 1.4 Conclusions: Total 24 hour postoperative cumulative opioid doses after sciatic nerve blockade in patients over 70 are lower than in younger patients. Further observations in greater numbers of patients and improved ultrasound to assess sciatic nerve structure in the elderly are warranted to study this effect.

Abstract Title: Ultrasound Guided Trans-sartorial Continuous Saphenous Nerve Blockade - A technique for Relief of Postoperative Medial Incisional Foot and Ankle Pain

The saphenous nerve (SaN) innervates the region from the upper medial thigh to the medial aspect of the foot and ankle. A femoral nerve block (FNB) is effective for blockade of the SaN but this causes quadriceps weekness and reduced patient mobility that is unsuitable in an ambulatory surgical setting.

Transverse-Plane Ankle Rotation for Lower-Limb Amputees Using Two Novel Prostheses

Thesis (Ph.D.)--University of Washington, 2016-06

Open Source Information Technologies Approach for Moddeling of Ankle-Foot Orthosis

Computer modeling is a perspective method for optimal design of prosthesis and orthoses. The study is oriented to develop modular ankle foot orthosis (MAFO) to assist the very frequently observed gait abnormalities relating the human ankle-foot complex using CAD modeling. The main goal is to assist the ankle- foot flexors and extensors during the gait cycle (stance and swing) using torsion spring. Utilizing 3D modeling and animating open source software (Blender 3D), it is possible to generate artificially different kind of normal and abnormal gaits and investigate and adjust the assistive modular spring driven ankle foot orthosis.

Acute Posterior Ankle Pain in a Female Recreational Soccer Player

Os trigonum syndrome, a musculoskeletal disorder causing posterior ankle pain, occurs in approximately one in every 13 people. This condition can be challenging for the athletic trainer when evaluating an acute ankle injury. We present a unique case of an os trigonum successfully treated with conservative rehabilitation without a definitive diagnosis.

Effects of hypergravity on fiber type and muscle mass in ankle extensors, including a compartmentalized muscle

Mice (30+-3 days old) were exposed to hypergravity (4G, one hour/day). Cross-sections of ankle extensor muscles stained immunohistochemically against slow myosin (MHC) determined if hypergravity affects the distribution of slow muscle fibers. Comparisons (ANOVA) between exposed and unexposed animals show hypergravity causes increases in slow fiber density in soleus after fourteen (p=0.049) and thirty day (p=0.Ol9) exposures. Therefore, loading may induce faster development of soleus through increased slow fiber density. Slow fibers increase in plantaris in males after seven (p=0.008) and in females after fourteen days (p=0.003), suggesting hypergravity delays normal elimination of slow fibers. Lateral and intermediate heads of lateral gastrocnemius (LG) show greater numbers of slow fibers, overall, in exposed mice (p=0.003 both). A proximal compartment of LG (LGp) and medial gastrocnemius (MG) are minimally affected by hypergravity. In LGp, only males exposed for fourteen days show decreased slow fiber density (p=0.047), but MG increased slow fiber numbers in exposed females compared to controls (p=0.04).

Use of a textured insole to improve the association between postural balance and ankle discrimination in young male and female dancers