Abstract
BackgroundChronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups.MethodsA consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed.ResultsOne hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p < 0.0001) and during movement (p < 0.0001) significantly decreased during the follow-ups; at 6 months, 13 patients suffered from CPS. Over time, satisfaction remained stable (p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p < 0.0001). No significant impact of type of anaesthesia could be detected. ASA 3 (p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction.ConclusionsBoth ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up.Trial registrationClinical Trial NCT02886221. Registered 1 September 2016.
Highlights
Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and on hallux valgus (HV) percutaneous correc‐ tion
The classification of the HV deformity was based on the presence of one of the following Mann and Coughlin parameters [23]: mild HV was defined as an intermetatarsal angle (IMA) ≤ 11° and a metatarsophalangeal hallux valgus angle (HVA) < 20°, and less than 50% subluxation of the medial sesamoid; moderate HV was defined as an IMA > 11 degrees but < 16 degrees and a HVA of 20 ° to 40 °, with 50 to 75% subluxation of tibial sesamoid
While several studies have focused on the development of CPS after knee and hip surgeries [36,37,38], the literature still lacks studies concerning postoperative pain and CPS in foot and forefoot surgery and its prevalence after HV percutaneous correction
Summary
Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and on HV percutaneous correc‐ tion. The first paper on CPS was published by Crombie et al [3] in 1998, and the first accepted definition was proposed by Macrae in 2001 [4]: “CPS is a persistent pain that has developed after a surgical procedure, of at least 2 months duration and for which other causes (malignancy, chronic infection or a continuation of a pre-existing problem) have been excluded.”. This definition was later revised and implemented by the International Association of Pain Study (IAPS) [5]. Several studies have shown peripheral nerve blocks to be highly effective for patients having in-patient forefoot surgery, both in delaying the onset of pain and reducing pain in the early postoperative period [14, 15]
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