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SUMMARY
Anaesthetic trainees and consultants who enrolled in a regional anaesthetic workshop completed a questionnaire regarding their own ankle block practice. The questionnaire focused on frequency of use, barriers to use, technique and perceived success rate. One hundred and twelve respondents participated, with 73% performing less than 10 ankle blocks per year. Forty-eight per cent believed that they did not have an appropriate operating list or a suitable patient, whilst 27% believed time constraints were the major barrier. Of those performing less than IO ankle blocks per year, 22% cited lack of anatomical knowledge or technique as their major barrier and 71 % perceived their success rate as medium to low. Eighty per cent performed their ankle block with the patient fully awake or sedated. Sixty-five per cent did not know the length of action of their ankle block. This survey supports recent suggestions that the practice of ankle block is under-utilized. Teaching workshops and clinical training for peripheral nerve blocks should receive high priority for the future.
Key Words: REGIONAL ANAESTHESIA, ANESTHESIA: ankle block, teaching, practice
Peripheral nerve blockade has become an increasingly popular form of anaesthesia as it provides excellent surgical conditions and good postoperative pain relief. Patients are now making informed choices about the type of anaesthesia they will receive: Fung and Cohen recently highlighted the value that outpatients place in communication and provision of information regarding anaesthesia options1.
Ankle block for mid- and forefoot surgery is a safe, simple, cost-effective peripheral nerve block that could be widely used and practised. Anaesthetists should be able to offer patients the choice of ankle block for foot surgery. There is, however, a paucity of clinical teaching in this area and information regarding Australian anaesthetic practice and barriers to practice is currently unavailable.
A recent survey of North American anaesthcsiologists demonstrated that 68% of respondents were prepared to perform ankle blocks on ambulatory patients2. The U.S.A. figure is high compared to other developed countries. In a survey in Germany, Tryba showed that 42% anaesthetists had no experience in administering knee or ankle blocks, with a further 29% having performed less than 20 blocks3. Tryba found that there were three main reasons for the low usage of peripheral blocks of the lower extremity: perception...