Ultrasound Guided Ankle Block versus Ultrasound Guided Combined Sciatic and Saphenous Nerve Blocks for Anesthesia and Postoperative Analgesia in Foot Surgeries

Background: Foot surgery often induces severe postoperative pain, necessitating substantial opioid use. Regional anesthesia provides effective analgesia, decreases opioid requirements, and enhances patient comfort. Using ultrasound guidance enhances the accuracy and effectiveness of performing peripheral nerve blocks.Aim of the work: To assess the safety and efficacy of ultrasound-guided AB vs CSNB among patients who undergo foot surgery.Methods: This prospective study included 50 adult patients undergoing foot or ankle surgery at Al-Azhar University Hospital, who were randomly allocated into two equal groups: the AB group (n = 25) and the CSNB group (n = 25). All nerve blocks were administered under ultrasound guidance using 0.25% bupivacaine combined with 4 mg of dexamethasone. Outcomes included sensory and motor block onset and duration, postoperative pain, time to first analgesic request, opioid consumption, hemodynamic stability, complications, and satisfaction.Results: Sociodemographic and surgical data were similar. CSNB achieved a faster onset (sensory: 12.1 ± 3.1 vs. 18.5 ± 4.2 min; motor: 16.4 ± 4.8 vs. 25.8 ± 5.6 min; p < 0.001) and longer duration (sensory: 835 ± 62 vs. 582 ± 45 min; motor: 510 ± 55 vs. 345 ± 38 min). It also prolonged analgesia (840 ± 60 vs. 585 ± 48 min; p < 0.001), reduced VAS scores up to 12 hours, and decreased opioid use (26.8 ± 19.7 vs. 71.3 ± 26.2 mg; p < 0.001).Conclusion: Ultrasound-guided CSNB provides faster onset, longer duration, superior analgesia, and reduced opioid consumption compared with AB, making it the preferred technique for foot surgeries requiring prolonged postoperative pain control.