Comparative Evaluation of Two Different Post-Operative Analgesia After Hallux Valgus Correction
Comparative Evaluation of Two Different Post-Operative Analgesia After Hallux Valgus Correction
Background: Recent studies showed the efficiency of several techniques of anesthesia in foot
 surgery. The new mini-invasive surgical approaches should require less analgesia and rapid
 motor recovery after surgery. The aim of this study was the evaluation of two different
 techniques on postoperative analgesia and motor recovery after hallux valgus correction in
 one-day surgery patients.
The hallux valgus surgery is often characterized by a significant post-operative pain
 difficult to control with oral analgesics. Consequently, large doses of parenteral opioids
 are often required Various nerve blocks (popliteal, saphenous, sciatic) can give excellent
 post-operative pain control. Among loco-regional anesthesia techniques, the sciatic nerve
 block provides good post-operative pain relief after foot surgery. Thus, sciatic nerve block
 with long-acting local anesthetics (with or without a peri-neural catheter) has been
 recommended as a primary option. This analgesic approach should cause a difficult discharge
 in ambulatory and one-day surgery patients, due to the prolonged motor recovery and loss of
 proprioception and protective pain reflexes. Therefore, it would be preferable to use the
 sciatic nerve block just for intra- operative anesthesia without affecting motor recovery,
 and to apply multimodal analgesia for post- operative pain management. Hallux valgus repair
 can now be done percutaneously, a minimally invasive technique called ''mini-invasive hallux
 valgus repair'', consisting in osteotomies through 3 to 5 mm incisions, without internal
 fixation. This approach requires less dissection and exposure, determining a smaller
 inflammatory response and theoretically causing less pain. Ideal anesthesia for these
 procedures should provide rapid patient recovery, minimal nursing care requirements in the
 post- anesthesia care unit and an earlier hospital discharge. It must provide effective
 analgesia, since the foot surgery is known to induce a moderate-to- severe post-operative
 pain, that represents one of the major limitations to hospital discharge on the day of
 surgery and is the main cause of re-admission.

 The aim of this matched-control study was to evaluate two different techniques of
 post-operative analgesia after hallux valgus correction in one-day surgery patients.
Inclusion Criteria:

 -  hallux valgus deformity

 -  pain

 -  walking difficulty with shoes

 Exclusion Criteria:

 -  peripheral circulatory disorders

 -  foot skin lesion

 -  local anesthetic allergy