Multi-modal-analgesia for pain management after Hallux Valgus surgery: a prospective randomised study on the effect of ankle block

doi:10.1186/1749-799X-2-26

Journal of Orthopaedic Surgery and Research

Volume 2

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Assareh H
Rolf C
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Research article

Multi-modal-analgesia for pain management after Hallux Valgus surgery: a prospective randomised study on the effect of ankle block

Ibrahim Turan¹^* , Hamid Assareh¹^* , Christer Rolf²^* and Jan Jakobsson¹

¹Karolinska Institutet, Foot & Ankle Surgical Centre, Stockholm, Sweden

²Sheffield Centre of Sports Medicine, University of Sheffield, UK

author email corresponding author email* Contributed equally

Journal of Orthopaedic Surgery and Research 2007, 2:26doi:10.1186/1749-799X-2-26


Published:	18 December 2007

Abstract

Background

Pain and emesis are the two major complaints after day case surgery. Local anaesthesia has become an important part of optimizing intra and post-operative pain treatment, but is sometimes not entirely sufficient. The aim of the present study was to study the effect of adding an ankle block to a multi-modal analgesic approach on the first 24-hour-need for rescue analgesia in patients undergoing elective Hallux Valgus surgery.

Type of study

Prospective, randomized patient-blind study comparing ankle block with levo-bupivacaine, lidocaine and Saline placebo control.

Methods

Ninety patients were studied comparing ankle block (15 cc) using levo-bupivacaine 2.5 mg/ml, lidocaine 10 mg/ml or placebo (saline) on day-case elective Hallux Valgus surgery, supported by general anaesthesia in all cases. Primary study endpoint was number of patient's requiring oral analgesics during the first 24 post-operative hours.

Results

Ankle block had no effect on need for rescue analgesia and pain ratings during the 1^st24 postoperative hours, there was no difference seen between placebo and any of the two active local anaesthesia studied. The only differences seen was that both lidocaine and levo-bupivacaine reduced the intra-operative need for anaesthetic (sevoflurane) and that levo-bupivacaine patients had a lower need as compared to the lidocaine patients for oral analgesics during the afternoon of surgery.

Conclusion

Adding a single shot ankle block to a multi-modal pain management strategy reduces the need for intra-operative anaesthesia but has no major impact of need of rescue analgesics or pain during the first 24-hour after surgery.