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Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in ambulatory patients

Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in Anesthe´sie et analge´sie postope´ratoire apre`s chirurgie de l’hallux valgus par voie percutane´e en F. Adam E. Pelle-Lancien , T. Bauer N. Solignac D.I. Sessler M. Chauvin a De´partement d’anesthe´sie-re´animation, hoˆpital Ambroise-Pare´, Assistance publique–Hoˆpitaux de Paris, 9, avenue Charles-de–Gaulle, 92100 Boulogne-Billancourt, France b Service de chirurgie orthope´dique, hoˆpital Ambroise-Pare´, Assistance publique–Hoˆpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France c Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA d Inserm U987, service du de´partement d’anesthe´sie-re´animation, hoˆpital Ambroise-Pare´, Assistance publique–Hoˆpitaux de Paris, 9, avenue Charles-de-Gaulle, Background. – Postoperative 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 Study design. – Prospective, randomized study.
Methods. – Forty 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.
Results. – Demographic 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 Æ 1.4 hours) than patients in the sciatic group (19.2 Æ 9.5 hours; P < 0.0001).
Conclusion. – After 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.
ß 2012 Published by Elsevier Masson SAS on behalf of the Socie´te´ franc¸aise d’anesthe´sie et de re´animation Objectif. – Ce travail visait a` e´valuer l’analge´sie postope´ratoire du bloc sciatique versus des blocs me´tatarsiens dans la chirurgie de l’hallux valgus par voie percutane´e en ambulatoire.
Type d’e´tude. – E´tude prospective et randomise´e.
Patients et me´thodes. – Apre`s accord du comite´ d’e´thique et consentement e´claire´ e´crit, 40 patients devant eˆtre ope´re´s d’un hallux valgus par voie percutane´e sous anesthe´sie locore´gionale pe´riphe´rique ont e´te´ inclus dans cette e´tude. Apre`s randomisation, 20 patients ont e´te´ ope´re´s sous blocs me´tatarsiens et 20 patients sous bloc sciatique. Dans les deux groupes un volume de 30 mL de ropivacaı¨ne a` 7,5 % a e´te´ utilise´. L’analge´sie postope´ratoire comportait du parace´tamol code´ı¨ne´ et du biprofe´nid en prise syste´matique, et du tramadol en traitement de secours. La douleur, la reprise de la marche, la qualite´ du 0750-7658/$ – see front matter ß 2012 Published by Elsevier Masson SAS on behalf of the Socie´te´ franc¸aise d’anesthe´sie et de re´animation (Sfar).

Source: https://grecmip.eu/userfiles/file/PubliAnesthPostopHV_Page1.pdf

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