Popliteal Nerve Block for Acute Achilles Tendon Rupture Repair Surgery

Achilles tendon rupture is common, yet the value of popliteal nerve block for postoperative pain control during surgical repair remains uncertain. Despite widespread use, evidence supporting its analgesic effectiveness is limited, and both popliteal nerve block and Achilles tendon repair carry risks of nerve injury. This randomized, placebo-controlled trial will evaluate whether adding a popliteal nerve block to standard systemic analgesia improves postoperative pain and reduces opioid use in patients undergoing acute Achilles tendon rupture repair. Secondary outcomes will examine the incidence and impact of nerve complications on recovery, including return to physical activity and functional performance.

This will be a prospective, double-blinded, randomized controlled superiority trial conducted at Women's College Hospital (WCH). The study aims to enroll 80 patients (40 per group) undergoing ambulatory surgical repair of acute Achilles tendon ruptures.

Inclusion Criteria: * Age 18 - 65 * ASA classification: I - III * BMI \< 35 kg/m2 * Undergoing acute Achilles tendon rupture repair surgery as a day surgery procedure Exclusion Criteria: * Pre-existing neurological deficits or peripheral neuropathy in the distribution of the tibial or common peroneal nerves * Local infection * Contraindication to regional anesthesia (e.g., bleeding diathesis, coagulopathy) * History of use of over 30 mg oxycodone or equivalent per day * Contraindication to any component of a standard multi-modal analgesia * Allergy to local anesthetics * History of significant psychiatric conditions that may affect patient assessment * Pregnancy * Inability to provide informed consent * Patient refusal of popliteal nerve blockade * Prior Achilles tendon surgeries on the operative leg * Unable to speak or read English