title: Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in ambulatory patients.
abstract: 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 sooner after mid-foot block.
  
  
  METHODS
  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 (30mL 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±1.4hours) than patients in the sciatic group (19.2±9.5hours; P<0.0001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Département d'anesthésie-réanimation, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. frederic.adam@apr.aphp.fr
authors.forename: F
authors.initials: F
authors.lastname: Adam
authors.forename: E
authors.initials: E
authors.lastname: Pelle-Lancien
authors.forename: T
authors.initials: T
authors.lastname: Bauer
authors.forename: N
authors.initials: N
authors.lastname: Solignac
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.forename: M
authors.initials: M
authors.lastname: Chauvin
mesh_terms: D000556:Ambulatory Surgical Procedures; D000698:Analgesia; D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D019637:Orthopedic Procedures / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies