Achilles hero or heel? A systematic review of popliteal nerve block for achilles repair

Abstract

Achilles tendon rupture is an exceptionally common injury, particularly among athletes. Popliteal nerve block is often performed for pain relief during surgical Achilles repair; however, the evidence basis demonstrating its analgesic effectiveness is uncertain. Popliteal nerve block faces an especially high burden of proof in this setting, because percutaneous Achilles repair and popliteal nerve block are each independently associated with a relatively high risk of iatrogenic nerve injury, which is potentially catastrophic for athletes competing at any level. Therefore, we undertook a systematic review of the literature to understand the evidence basis for popliteal nerve block compared to systemic multimodal analgesia for Achilles repair surgery. We followed a predefined protocol (CRD42024577995) and adhered to PRISMA reporting guidelines. However, our systematic review of the published literature identified zero randomized trials comparing popliteal nerve block to systemic analgesia for Achilles repair surgery, and only one small retrospective cohort study which failed to demonstrate a significant difference in patient outcomes after popliteal nerve block versus systemic analgesia alone. There is presently no high-quality evidence to support or refute the routine administration of a popliteal nerve block relative to systemic analgesia for Achilles repair surgery. Providers, patients, and payers alike must recognize this major gap in the literature. Future randomized controlled trials are required to validate the analgesic effectiveness and safety profile of popliteal nerve block compared to systemic analgesia for surgical Achilles repair.