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 |
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 |
