Sciatic nerve blockade: a survey of orthopaedic foot and ankle specialists in North America and the United Kingdom.
BACKGROUND
Sciatic nerve blocks are used to reduce post-operative pain and allow early discharge for patients undergoing foot and ankle surgery. This study aimed to identify the utilization of this procedure in the US and UK and to establish the standard of care with respect to the level of anesthesia that the patient is under and use of ultrasound localization when performing sciatic nerve blocks.


METHODS
A survey of current committee members of AOFAS and members of BOFAS.


RESULTS
Two hundred sixty-three surgeons were contacted with a response rate of 44%. Eighty-two percent commonly used a sciatic nerve blockade. Sixty-nine percent never or only sometimes used ultrasonography and variable levels of nerve stimulation were used. Forty-two percent where happy to have the block performed under full anesthesia. There were significant differences between British and American practices regarding the level of nerve stimulation and the level of anesthesia used. The most common complication cited was prolonged anesthesia of which the vast majority spontaneously resolved. Performing blocks awake or sedated did not seem to alter number of complications seen.


CONCLUSIONS
This study represents a current practice review of sciatic nerve blocks performed amongst senior foot and ankle surgeons. Although no absolute consensus has been reached as to the use of ultrasound or whether the patient needs to be awake for the procedure, it is clear that the standard of care does not mandate either of these. The differences between US and UK practice are probably cultural and do not appear to affect the number of complications encountered.
Hamilton
Paul D
PD
Department of Trauma and Orthopedic Surgery, Basingstoke and North Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
Pearce
Christopher J
CJ
Pinney
Stephen J
SJ
Calder
James D F
JD
D000768:Anesthesia, General / Q000706:statistics & numerical data; D002404:Catheterization / Q000706:statistics & numerical data; D016292:Procedural Sedation / Q000706:statistics & numerical data; D004558:Electric Stimulation; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D009985:Orthopedics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012584:Sciatic Nerve; D011795:Surveys and Questionnaires; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data; D006113:United Kingdom; D014481:United States