Ether Resources for Anesthesia Research and Education

Anesthesia Protocol for Ankle and Foot Surgery

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Anesthesia: Suma Ramzan, Lindsey Vokach-Brodsky
Surgeon: Loretta Chou


Background: Since standardization may improve outcome and safety, the Department
of Anesthesiology is working with the orthopedic service to help provide a standard
operating procedure for the best practice of anesthesia and postoperative pain control.
We are attempting to combine efficient practice with the best anesthesia care to optimize
surgical conditions. We understand, however, that each patient has unique
characteristics, but the document is intended to serve as a guideline for care.


Increasing Efficiency

  Surgeons Nurses Anesthesia
in room
Regional
team
721-6276
First case - Make attempts at
scheduling non regional cases as first case of the day
- Schedule patients as
G/R when appropriate
- Patients are informed in clinic that several anesthesia options will be made available day of surgery
- Ensure that consents
up to date.
- Preop nurses to make it a priority to get regional patients ready - Place the IV.
- Allow regional team to take priority in
speaking with
the patient to
allow sufficient
time for the
block.
- Regional
resident to call
preop holding
and prioritize 2
patients for
blocks to be
made ready
- Make efforts
to have no blocks start 20
minutes prior to
surgery start
time.
Subsequent
cases
- Towards the end of
the hour of the case in
the OR notify
anesthesiologist time to put in next block.
- Preop nurses to make it a priority to get regional
patients ready
- Call in patients
3 hours in
advance (after the first case of the day) if case
booked as G/R

- Communicate
with the regional team an hour before case start to place blocks

 

 

Information on types of blocks

  • Naturally GA is also available to all procedures where patients refuse blocks.
  • Dr. Chou has requested muscle relaxation (MR) for some cases and this should be
    clarified with discussion between the anesthesia team in the room and the
    surgeon.
  • Most of Dr. Chou’s cases are 2-3 hours so MAC patients should be prepared.
  • Consideration for popliteal catheters should be on a case-by-case basis.
  • No toradol for fractures, fusions and arthrodesis.
Case
Position Tourniquet
placement
Preferred
anesthesia
Secondary
option
Regional
only
option
Fusion/Arthrodesis
ankle, subtalar, double, triple
Supine Thigh Popliteal
block + GA
SAB Femoral +
Sciatic
Fractures
ORIF ankle, lateral
malleolus, bimalleolar,
trimalleolar ,calcaneus,
talus, lisfranc
Supine Thigh Popliteal +
GA +/-
muscle
relaxation
(MR)
SAB Femoral +
Sciatic
Arthroscopy
OATS, ankle arthroscopy
Supine Thigh Popliteal +
GA with
MR
  none
Forefoot
hammer toes, distal
metatarsal osteotomy,
bunion, hallux valgus,
chevron osteotomy,
proximal crescentic
osteotomy, 1st MTPJ
arthrodesis/fusion
Supine Ankle
esmarch
Popliteal +
Saphenous
+ MAC
Ankle block
+ MAC
See
previous
Ligaments and tendons
modified brostrom
procedure, bridle
procedure, posterior
tibial tendon
reconstruction
Supine Thigh Popliteal +
GA
SAB Femoral +
Sciatic
Posterior Foot
calcaneal osteotomy
Supine Thigh Popliteal +
GA
SAB Femoral +
Sciatic
Posterior Foot
achilles repair
Prone Thigh Popliteal +
GA
SAB Femoral +
Sciatic

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