ANKLE BLOCK COMBİNED WİTH GENERAL ANAESTHESIA VERSUS SPINAL ANAESTHESIA IN OUTPATIENT FOOT SURGERY
E. Sezer1, M. Özhan2, C. Caparlar1 
1University of Health Sciences - Dıskapı Yıldırım Beyazıt Training and Research Hospital, Anaesthesiology and Reanimation Clinic, Ankara, Turkey.
2Private Çankaya Hospital, Anaesthesiology and Reanimation Clinic, Ankara, Turkey.

Background and Aims
Postoperative pain and immobilization are major problems which negatively affect patient’s discharge in outpatient foot surgery (OFS). The aim of this retrospective study was to compare spinal anaesthesia (SA) with general anaesthesia (GA) combined with ankle blocks (AB) in terms of postoperative analgesia and length of hospital stay (LHS) in OFS. 
Methods
After hospital's ethic committee approval, medical records of patients who underwent OFS between June and December 2017 were evaluated. ASA I-II, 87 patients were included in the study; 46 patients had received SA (Group SA) using 15 mg of 0.5% heavy bupivacaine, 41 patients (Group GA/AB) had received GA (propofol-remifentanyl based TIVA) combined with ankle block using 4 ml of local anaesthetic mixture containing 0.5% bupivacaine and 2% lidocaine for nerve blockage. Times to first analgesic requirement and to mobilization, mean analgesic consumption (acetaminophene) and LHS were compared. Discharge from hospital was assessed using Post Anaesthesia Discharge Scoring System (PADSS).
Results
Demographic variables and duration of the surgery were similar between groups (Table I). In group GA/AB mean analgesic consumption was lower and the time to first analgesic requirement was higher, while the time to mobilization and LHS were increased in group SA (p<0.05). In group SA, two patients had urinary retention and one patient was admitted to hospital after discharge due to postspinal headache (Table II).
Conclusions 
Combination of ankle blocks with GA has provided superior analgesia and faster discharge with less motor impairment and without bladder dysfunction compared to SA.
References
1. Pearce CJ, FRCS, MFSEM, Hamilton PD, Current Concepts Review: Regional Anesthesia for Foot and Ankle Surgery, Foot & Ankle International, 2010 August,  Vol. 31, No. 8. 
2. Urfalioglu A, Gokdemir O, Onur Hanbeyoglu O et al, A comparison of ankle block and spinal anesthesia for foot surgery,  Int J Clin Exp Med 2015;8(10):19388-19393. 
3. Kopp SL, Horlocker TT, Regional anaesthesia in day-stay and short-stay surgery, Anaesthesia, 2010, 65 (1), 84–96.
4. Loader J, McCormick B, Anaesthesia for foot and ankle surgery - general and regional techniques, Update in Anaesthesia 2000; 11: 56-66.
5. Mulroy MF, McDonald SB, Regional anesthesia for outpatient surgery, Anesthesiology Clin N Am,  2003, (21), 289– 303.

TABLES I and II