Podiatric Surgeons often perform surgery on a day-case basis under local anaesthesia – you will therefore be awake during the surgery. This is done using a series of injections at the toe, ankle or knee. Using this form of anaesthesia has a lower risk than is associated with general anaesthesia. Local anaesthesia is any technique used to render part of the body insensitive to pain without affecting consciousness; regional anaesthesia involves a larger part of the body, for example, the foot or arm. Local anaesthetic drugs produce a reversible loss of sensation or function by preventing the conduction of nerve impulses and have been used in medical practice for more than a century. The anaesthesia works by taking away the pain but not the sensation of touch – you will not feel any pain during the operation though you will feel the surgeon touching the foot. Depending on the choice of drug and technique used, the local anaesthetic will wear off many hours after surgery.

As Podiatric Surgery is often performed using local anaesthetic on a day case basis, patients must, therefore:

1. Be medically fit enough to undergo surgery
2. Have home circumstances which allow them to return home the same day of surgery
3. Be physically able, and willing, to comply with the postoperative regime.

The option to perform local or regional anaesthesia was traditionally reserved for the medically unfit patient but now it has become the first choice for some anaesthetists. Studies demonstrating safer practice, reduced costs and high patient satisfaction have been published to validate their place in modern anaesthesia. Peripheral nerve blocks have become an increasingly popular form of anaesthesia as they provide excellent surgical anaesthesia and good postoperative pain relief with minimum side effects. They can produce dense analgesia and therefore reduce the need for post-operative painkillers, hence reducing the chances of related side-effects such as gastrointestinal disturbances. The hallux block is the classic example of anaesthesia in Podiatry, commonly used for the treatment on ingrown toenails. The ankle block is a well described and successful technique of providing surgical anaesthesia and post operative analgesia for midfoot and forefoot surgery. Five peripheral nerves are blocked at this level.

The popliteal block is increasingly being used by Podiatric Surgeons to carry out surgery of the foot and ankle. The popliteal block was originally described in 1923 with desirable characteristics that make it highly suitable for foot and ankle surgery. Using a popliteal block has the following advantages for the patient:

1. Prolonged anaesthesia – up to 50 hours has been reported which is especially useful for day-case surgery and may reduce the need for high dose opioid painkillers
2. It eliminates the pain of an ankle tourniquet
3. It allows the use of a mid-calf tourniquet (which is often more painful than an ankle tourniquet), facilitating the performance or rearfoot and tendo Achilles surgery development of safer, long lasting local anaesthetics for peripheral nerve blocks has helped the development of safer practice. Speak to your podiatric surgeon or anaesthetist about the options for local and regional anaesthesia.

Acknowledgment
Akram Uddin. Clinical Assistant (Podiatric Surgery),
Northamptonshire tPCT

Mr. I Reilly FCPodS, DMS
Consultant Podiatric Surgeon
Department of Podiatry
Northampton tPCTThe Capio Woodland HospitalRothwell Road
KETTERING
http://www.podsurgeon.co.uk

Contributed by Dr. Kushal Nag, M.B.B.S., M.S. (Ortho)