Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in ambulatory patients |
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Authors: | F Adam E Pelle-Lancien T Bauer N Solignac DI Sessler M Chauvin |
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Institution: | 1. Département d’anesthésie-réanimation, hôpital Ambroise-Paré, Assistance publique–Hôpitaux de Paris, 9, avenue Charles-de–Gaulle, 92100 Boulogne-Billancourt, France;2. Service de chirurgie orthopédique, hôpital Ambroise-Paré, Assistance publique–Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France;3. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA;4. Inserm U987, service du département d’anesthésie-réanimation, hôpital Ambroise-Paré, Assistance publique–Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France |
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Abstract: | BackgroundPostoperative pain is often severe after hallux valgus repair. Sciatic nerve blocks with long-acting local anesthetics have been recommended for surgical anesthesia and postoperative analgesia. However, a novel percutaneous approach may require less analgesia and make the procedure suitable for ambulatory care. We thus tested the hypothesis that mid-foot block and sciatic nerve blocks provide comparable surgical anesthesia and postoperative analgesia, but that patients ambulate independently sooner after mid-foot block.Study designProspective, randomized study.MethodsForty patients scheduled for ambulatory percutaneous hallux valgus repair were randomly assigned to two anesthesia and analgesia blocks: foot infiltration achieved by a mild foot block, or sciatic nerve block (30 mL of 7.5% ropivacaine for each block). Surgery was performed without sedation or additional analgesia. Both groups were given oral paracetamol/codeine and ketoprofene systematically; tramadol was added if necessary. Walking ability and pain scores were assessed for 48 postoperative hours.ResultsDemographic and morphometric characteristics, and duration of surgery were similar in each group. Pain scores were comparable and low in each group at rest and while walking. The time to ambulation without assistance was significantly less for patients in the infiltration group (3.8 ± 1.4 hours) than patients in the sciatic group (19.2 ± 9.5 hours; P < 0.0001).ConclusionAfter percutaneous hallux valgus repair, mid-foot block and sciatic nerve block provided comparable postoperative analgesia. However, mid-foot block seems preferable since the time to ambulation without assistance is much reduced. |
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Keywords: | Postoperative pain Hallux valgus Mid-foot block Sciatic nerve block Ambulatory surgery |
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