Abstract
Introduction:The aim of this study was the evaluation of two different techniques on post-operative analgesia and motor recovery after hallux valgus correction in one-day surgery patients.Material and Methods:We enrolled 26 patients scheduled for hallux valgus surgery and treated with the same surgical technique (SCARF osteotomy). After subgluteal sciatic nerve block with a short acting local anaesthetic (Mepivacaine 1.5%, 15ml), each patient received an ultrasound-guided Posterior Tibialis Nerve Block (PTNB) with Levobupivacaine 0.5% (7-8ml). We measured the postoperative intensity of pain using a Visual Analogue Scale (VAS), the consumption of oxycodone after operative treatment and the motor recovery. VAS was detected at baseline (time 0, before the surgery) and at 3, 6, 12 and 24 hours after the operative procedure (T1, T2, T3, T4 respectively). Control group of 26 patients were treated with another post-operative analgesia technique: local infiltration (Local Infiltration Anaesthesia, LIA) with Levobupivacaine 0.5% (15ml) performed by the surgeon.Results:PTNB group showed a significant reduction of VAS score from the sixth hour after surgery compared to LIA group (p<0.028 at T2, p<0.05 at T3 and p<0.002 at T4, respectively). Instead, no significant differences were found in terms of post-operative oxycodone consumption and motor recovery after surgery.Conclusions: PTNB resulted in a valid alternative to LIA approach for post-operative pain control due to its better control of post-operative pain along the first 24 hours. In a multimodal pain management according to ERAS protocol, both PTNB and LIA should be considered as clinically effective analgesic techniques.
Highlights
The aim of this study was the evaluation of two different techniques on post-operative analgesia and motor recovery after hallux valgus correction in one-day surgery patients
During the first three hours no significant differences could be detected in terms of Visual Analogue Scale (VAS) values between the two analgesic techniques, but from the sixth hour after surgery until discharge from the hospital the Study Group (SG) presented a significant reduction of VAS values compared to control group (CG) (p
The first oxycodone administration occurred in both groups eight hours after the operative procedure at the least and the average dose administered in both groups was 7mg (6.73 ± 5.28 in SG, 7.31 ± 5.14 in CG, p = 0.69)
Summary
The aim of this study was the evaluation of two different techniques on post-operative analgesia and motor recovery after hallux valgus correction in one-day surgery patients. In hallux valgus surgery sciatic nerve block with long acting local anaesthetics (with or without a perineural catheter) has been advocated as a primary option[513], to avoid the administration of large doses of parenteral opioids due to significant post-operative pain[5,6,7,8]. This analgesic approach may cause a difficult discharge in ambulatory and one-day surgery patients, due to the prolonged motor recovery and loss of proprioception and protective pain reflexes[14,15]. Sciatic nerve block (just for intraoperative anaesthesia without affecting motor recovery) and multimodal analgesia for post-operative pain management, instead, may accelerate patient recovery and discharge
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