Use of peripheral blocks and tourniquets in foot surgery: A survey of Australian orthopaedic foot and ankle surgeons

- We are the first to describe the current use of peripheral blocks and tourniquets in Australia representing a modern western country.
- The current practice of Australian foot surgeons is not based on evidence but individual preferences.
- Most Australian foot and ankle surgeons were reluctant to use local anaesthetic techniques without accompanying GA.
- Popliteal block + GA was preffered for hindfoot surgery and ankle block + GA for more distal procedures.
- Everyone used a tourniquet for surgery, mostly placed on the thigh.

BackgroundThe most common reasons for unplanned admission to the hospital from outpatient surgery have the potential to be minimised or eliminated by peripheral nerve blocks (PNB). Tourniquets are commonly used in elective extremity surgery but it's use is mostly guided by personal preferences and does no correlate with the existing literature. Our aim was to explore the current practice of PNB and tourniquet use by foot and ankle surgeons in Australia.MethodsThe Australian Orthopaedic Foot and Ankle Surgery Society (AOFAS) annual meeting was held in Adelaide in 2011. Members were asked to complete an electronic survey on their current use of peripheral nerve blocks and tourniquets. Two specific elective case scenarios were included for comment, one pertaining to forefoot pathology, the other hindfoot pathology.ResultsTwenty-three AOFAS members replied to the survey, an overall response rate of 76.6%. Of these, only two surgeons did not use ankle blocks in elective surgery and none were prepared to operate without a tourniquet. Most Australian foot and ankle surgeons were reluctant to use local anaesthetic techniques without an accompanying GA.ConclusionsWhile the literature suggests that GA may add to complications without any benefit for the procedure and that distally based tourniquets may add benefit, these are not the favoured techniques in Australian foot and ankle surgeons.