Anesthesia Protocol for Ankle and Foot Surgery

1 Anesthesia Protocol for Ankle and Foot Surgery 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 Regional in room team 721-6276. First case - Make attempts at - Preop nurses to - Place the IV. - Regional scheduling non regional make it a priority - Allow resident to call cases as first case of the to get regional regional team to preop holding day patients ready take priority in and prioritize 2. - Schedule patients as speaking with patients for G/R when appropriate the patient to blocks to be - Patients are informed allow sufficient made ready in clinic that several time for the - Make efforts Anesthesia options will block.

2 To have no be made available day blocks start 20. of Surgery minutes prior to - Ensure that consents Surgery start up to date. time. Subsequent - Towards the end of - Preop nurses to - Communicate cases the hour of the case in make it a priority with the the OR notify to get regional regional team anesthesiologist time to patients ready an hour before put in next block. - Call in patients case start to 3 hours in place blocks advance (after the first case of the day) if case booked as G/R. 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 Preferred Secondary Regional placement Anesthesia option only option Fusion/Arthrodesis Supine Thigh Popliteal SAB Femoral +.

3 Ankle , subtalar, double, block + GA Sciatic triple Fractures Supine Thigh Popliteal + SAB Femoral +. ORIF Ankle , lateral GA +/- Sciatic malleolus, bimalleolar, muscle trimalleolar ,calcaneus, relaxation talus, lisfranc (MR). Arthroscopy Supine Thigh Popliteal + none OATS, Ankle GA with arthroscopy MR. Forefoot Supine Ankle Popliteal + Ankle block See hammer toes, distal esmarch Saphenous + MAC previous metatarsal osteotomy, + MAC. bunion, hallux valgus, chevron osteotomy, proximal crescentic osteotomy, 1st MTPJ. arthrodesis/fusion Ligaments and Supine Thigh Popliteal + SAB Femoral +. tendons GA Sciatic modified brostrom procedure, bridle procedure, posterior tibial tendon reconstruction Posterior Foot Supine Thigh Popliteal + SAB Femoral +. calcaneal osteotomy GA Sciatic Posterior Foot Prone Thigh Popliteal + SAB Femoral +. achilles repair GA Sciatic