R. Samuel and A. Zubairy reply:
We thank Mr. Jameson and Mr. Kumar for their interest in our article. We agree that it is intuitive that two regional blocks will provide better pain relief than one after forefoot surgery, but until the study was performed this could not be proved. Because of the deliberately chosen variety of cases that were used in the study, we had a mixture of day-case patients and inpatients. One patient who had a popliteal block and was due for discharge the same day required overnight admission because of prolonged numbness in the leg. No other patient had a delayed discharge because of the type of block used.
Statistical analysis of the analgesia requirements was performed and is stated in the article. Although no significant difference was seen between the two groups, codeine phosphate consumption was less in the combined block group (18 compared with 78 mg). We agree that the sample size may have been insufficient to detect significance. Although combined popliteal and ankle blocks may appear to be unnecessary in cases of lesser forefoot surgery, we believe that such treatment is worth considering in cases of larger procedures in which postoperative analgesia may be predicted to be a problem.
These letters originally appeared, in slightly different form, on . They are still available on the web site in conjunction with the article to which they refer.