title: Triple nerve block at the knee for foot and ankle surgery performed by the surgeon: difficulties and efficiency.
abstract: BACKGROUND
  Combined nerve blocks at the knee can provide safe anesthesia below the knee avoiding the potential complications of general or spinal anesthesia while reducing the need for opioids in the postoperative period. This study presents the outcomes of a large series of patients that underwent foot and ankle surgery receiving a triple nerve block at the knee.
  
  
  METHODS
  Three hundred eighty patients underwent foot and ankle surgery receiving anesthesia with triple nerve block at the knee (tibial, common peroneal and saphenous nerve). Surgery included a variety of bone and soft tissue procedures. The nerve block was performed by an orthopaedic surgeon in the lateral decubitus position.
  
  
  RESULTS
  The successful nerve block rate was 91 percent. There was no need to convert to general or spinal anesthesia, although 34 patients (9%) needed additional analgesia intraoperatively. Complete anesthesia required 25 to 30 minutes from the time of performing the block. No complication occurred secondary to the use of the anesthetic agent (ropivacaine 7.5%). Postoperative analgesia lasted from 5 to 12 hours, reducing the need of additional analgesics. Hospitalization averaged 1.4 days (from 0 to 5) with the majority of patients discharged the day after the operation (248/380). A high satisfaction rate was reported by the patients with no adverse effects and complications.
  
  
  CONCLUSIONS
  We found triple nerve block at the knee to be a safe and reliable method of regional anesthesia providing low morbidity, high success rate, long acting analgesia, and fewer complications than general or spinal anesthesia. It is a simple method that can be performed by the orthopaedic surgeon.
authors.affiliation: University of Thessalia School of Medicine, Larissa, Greece. svaritimidis@ortho-uth.org
authors.forename: Sokratis E
authors.initials: SE
authors.lastname: Varitimidis
authors.forename: Aaron I
authors.initials: AI
authors.lastname: Venouziou
authors.forename: Zoe H
authors.initials: ZH
authors.lastname: Dailiana
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Christou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Dimitroulias
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Malizos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000842:Ankle; D015331:Cohort Studies; D005260:Female; D005534:Foot Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007717:Knee / Q000294:innervation; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures; D010543:Peroneal Nerve; D012189:Retrospective Studies; D013979:Tibial Nerve; D016896:Treatment Outcome; D055815:Young Adult