SLR - October 2016 - Farid Didari

Postoperative Pain and Preemptive Local Anesthetic Infiltration in Hallux Valgus Surgery

Reference: Gadek A, Liszka H, Wordliczek J. Postoperative Pain and Preemptive Local Anesthetic Infiltration in Hallux Valgus Surgery. Foot Ankle Int. 2015 Mar; 36(3): 277–281.

Scientific Literature Review

Reviewed By: Farid Didari, DPM
Residency Program: Chino Valley Medical Center, Chino, California

Podiatric Relevance: There is no standard of care for postoperative pain management for outpatient podiatric procedures. Different foot and ankle surgeons try different methods including preoperative and postoperative local anesthesia, regional anesthesia and different oral pain medications. In this study, the author tried preemptive local anesthesia for patients undergoing hallux valgus surgery and evaluated their postoperative pain level.  
Methods: In this study, they evaluated 118 patients who underwent modified chevron and Mitchell-Kramer bunionectomy of the first distal metatarsal. After spinal anesthesia each patient randomly received an infiltration of local anesthetic or the same amount of normal saline 10 minutes before the skin incision. They measured the intensity of pain 4, 8, 12, 16, 24 and 72 hours after the release of the tourniquet using a visual analogue scale. Rescue analgesia and all other side effects were noted.

Results: Patients who underwent preemptive analgesia experienced less pain during the first 24 hours after surgery. The decrease of VAS score was significantly lower in the study group during all the short postoperative periods measured. The rescue analgesia was administered in 11.9 percent of patients in the injected group and 42.4 percent in the placebo group (P<.05). In the injected group, they did not observe significant difference in VAS score between patient’s post-chevron and Mitchell-Kramer osteotomy of the first distal metatarsal. No systemic adverse effects were noted. One persistent injury of dorsomedial cutaneous nerve was observed.

Conclusions: Preemptive local anesthetic infiltration was an efficient and safe method to reduce postoperative pain after hallux valgus surgery.  The analgesic effect was satisfactory in both traditional and minimally invasive techniques. I have heard multiple times from postop patients that their pain level was highest between 12 and 24 hours after surgery. I believe preemptive local anesthetic infiltration for hallux valgus surgeries is a good modality in early postoperative pain level control.

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