SLR - May 2022 - Samuel Mason, DPM
Reference: Biz C, de Iudicibus G, Belluzzi E, Dalmau-Pastor M, Bragazzi NL, Funes M, Parise GM, Ruggieri P. Prevalence Of Chronic Pain Syndrome In Patients Who Have Undergone Hallux Valgus Percutaneous Surgery: A Comparison Of Sciatic-Femoral And Ankle Regional Ultrasound-Guided Nerve Blocks. BMC Musculoskelet Disord. 2021 Dec 15;22(1):1043.Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Samuel Mason, DPM
Residency Program: Northwest Medical Center – Margate, Florida
Podiatric Relevance: Hallux valgus surgery describes a myriad of forefoot procedures which are common in the podiatric community. These procedures are performed daily with varying types of anesthesia used for perioperative pain management. Of the various anesthesia techniques, nerve blocks are commonly administered to patients perioperatively by either the podiatric or anesthesia team. Many podiatric surgeons believe sciatic-femoral blocks to be superior in preventing chronic pain syndrome (CPS) and in controlling pain in the post-operative period. This article aims to compare sciatic-femoral nerve to ankle blocks in their efficacy in post-operative pain management and determine if there is a relationship in preventing CPS in hallux valgus percutaneous surgery.
Methods: Over the course of two years, a consecutive series of 150 patients (28 male, 127 female), were enrolled in the study and divided into two groups according to their type of received anesthesia for their surgery (ankle versus sciatic-femoral blocks). The study evaluated their pain at rest, pain with motion, patient satisfaction, quality of life, return to daily activities, and incidence of CPS in the intervals of seven days, one, three, and six months following their surgical hallux valgus correction. All surgeries were performed by the same surgeon using a similar, minimally invasive technique for Akin and Reverdin-Isham osteotomies. All nerve blocks were administered by one of the three senior anesthesiologists at the facility with ultrasound assistance. Other perioperative medications, which impact pain control, were kept the same between the two groups. Strict inclusion and exclusion criteria were implemented which included screening of patient comorbidities (specifically those that alter the perception of pain, or are responsible for chronic pain in the foot), the type of surgical correction, the severity of deformity, previous trauma, and psychiatric disorders. Patients were contacted via phone and during post-operative visits by an independent investigator blind to the patient’s allocated group.
Results: For both groups, continued pain reduction, stable satisfaction scores, and quality of life increases were noted over the course of the six months following the operation. Of the variables evaluated, no statistical significance was seen based on type of anesthesia, including for the development of CPS. Variables that were statistically significant in pain and satisfaction outcomes were ASA classification, lumbago, and BMI. No complications were recorded from either type of anesthesia administration.
Conclusion: The authors concluded that both ankle and regional blocks showed no superiority in incidence of chronic pain syndrome and overall patient satisfaction in the post-operative period. This article demonstrates that proper ankle blocks can provide comparable anesthesia to sciatic-femoral blocks. Going forward, this knowledge will decrease my requests for proximal blocks and decrease costs for the patient. Also, the factors determined to have clinical significance on surgical outcomes will remain in the forefront of my mind when discussing outcomes with patients that are obese, ASA class 3, or suffer from lumbago.