[Oral analgesia versus posterior tibial nerve block for postoperative pain in ambulatory open hallux valgus surgery: a randomized clinical trial].
BACKGROUND
This trial assessed the safety and efficacy of a continuous posterior tibial nerve block in the ankle provided in the patient's home by elastomeric pump infusion of 0.375% ropivacaine after ambulatory hallux valgus surgery.


METHODS
Patients were randomized to 2 groups of 20 each to receive either the conventional oral analgesia prescribed by our team after outpatient surgery (metamizole 575 mg/6 h p.o.) or perineural analgesia with a continuous infusion of 5 mL x h(-1) of 0.375% ropivacaine in the posterior tibial nerve. Surgery was performed under hyperbaric spinal anesthesia with mepivacaine and an injection of 0.25% bupivacaine into the joint. Both groups also received 50 mg/8 h p.o. of tramadol as rescue analgesia. Assessment during visits by the home care team 12, 24, and 48 hours after surgery included the following variables: pain on a visual analog scale (VAS, 0-10), sleep quality, need for rescue analgesia, acceptance of the technique, side effects and adverse events. Descriptive statistics were calculated and comparisons were performed with the Mann-Whitney U test; sleep quality and need for rescue analgesia were compared by applying the chi2 statistic with a test of linear trend.


RESULTS
The perineural analgesia group had significantly lower VAS scores at 4, 12, and 24 hours and less need for rescue analgesia. No differences in sleep quality were found (P0.07). The incidence of side effects did not differ, and there were no readmissions. The patients expressed a high level of acceptance of the technique.


CONCLUSIONS
Continuous perineural analgesia in the home setting was found to be effective and safe in our patients.
Ferrer Gómez
C
C
Servicio de Anestesiología y Reanimación, Hospital Universitari Joan XXIII, Tarragona. cafego77@hotmail.com
Puig Bitrià
R
R
Boada Pie
S
S
Recasens Urbez
J
J
Rull Bartomeu
M
M
D000556:Ambulatory Surgical Procedures; D000698:Analgesia; D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*; D010865:Pilot Projects; D011446:Prospective Studies; D013979:Tibial Nerve