[Comparison of the post-surgical analgesic effectiveness of tibial (at internal malleolus level) and common peroneal nerve block with infiltration of the surgical wound in Outpatient Surgery of the hallux valgus]

Abstract

Introduction: To compare the post-operative analgesic effectiveness of blocking the posterior tibial and the common peroneal nerves against that of wound infiltration using local anaesthesia, in ambulatory surgery of hallux valgus.

Material and methods: A randomised clinical study was conducted on ambulatory patients subjected to Hallux valgus surgery, assigned into two groups: BNP: peripheral nerve blockage: posterior tibial and the common peroneal with 80mg of lidocaine, 100mg of mepivacaine and 25mg of levobupivacaine. INF: surgical wound infiltration with 50mg of levobupivacaine. The following aspects were evaluated during the first 24h after surgery: pain level using a visual analogue scale (VAS), the need to use rescue analgesia, and the incidence of secondary effects and readmissions due to pain.

Results: A total of 111 Patients were included (55 BNP, 56 INF), 93 per cent were women and the average age was 59 (SD10) years. The average VAS score in the first 24h was 2.9 (SD1.7) for the BNP group and 2.7 (SD1.6) for the INF group (P=.62). Less than half (42%) of patients needed rescue anaesthetic with tramadol, with no significant differences between the groups (P=.28). A 33 per cent had secondary postoperative effects were observed in 33% of cases, with a significant difference between INF and BNP (P=.01). One patient from INF group, had to be admitted for pain.

Conclusions: The peripheral nerve block and wound infiltration are valid techniques for controlling pain at home after ambulatory surgery of hallux valgus, therefore both methods appear to be safe in an outpatient setting.