Perioperative Analgesia for Foot and Ankle Surgery: A Comprehensive Review.

Abstract

Foot and ankle surgery is often associated with significant postoperative pain that may delay mobilization and recovery. For this reason, effective perioperative analgesia is essential to improve outcomes, minimize opioid use, and enable safe early discharge when appropriate. This review provides an updated overview of regional anesthesia techniques for foot and ankle surgery, highlighting anatomical considerations, ultrasound guidance, and patient-tailored block selection. Different techniques will be specifically addressed over neuraxial and nerve blocks, such as the Mayo block and intravenous regional anesthesia (Bier block), as well as the emerging WALANT approach for selected cases. Ultrasound guidance has become a gold-standard, enhancing precision and safety compared to landmark-based methods. Multimodal analgesia combining regional blocks with non-opioid medications and adjuvants like intravenous dexamethasone further optimizes pain control while limiting opioid requirements. In ambulatory settings, motor-sparing techniques and short-acting spinal agents are emphasized to support rapid recovery and same-day discharge. By integrating anatomical knowledge with ultrasound and multimodal strategies, perioperative pain management for foot and ankle surgery can be tailored to balance effective analgesia with early mobilization and patient safety.