An Evaluation of Peripheral Sciatic Nerve Block in Patients Undergoing Hallux Valgus Surgery

Loh, Belinda; Padki, Akshay; Yeo, Nicholas EM; Thong, Szeying

doi:10.5005/jp-journals-10040-1185

Cited by 1 publication

(1 citation statement)

References 31 publications

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“…6,7 Several prospective randomized controlled trials have shown that peripheral nerve blocks represent a safe and effective choice for foot and ankle surgery, including hallux valgus correction. 5,[8][9][10] In particular, some studies have shown that Ultrasound Popliteal Sciatic Nerve Block (UPSNB) is a valid postoperative analgesia strategy for hindfoot and forefoot surgery, 11 being associated with fewer complications as compared to other type of nerve blocks (such as neuraxial block or ankle block). 11 Over the years, different medications, such as opioids, epinephrine, sodium bicarbonate, magnesium sulfate, dexamethasone, ketamine, neostigmine, midazolam, clonidine, and dexmedetomidine have been combined with local anesthetics (LA) to increase the duration of anesthesia or analgesia.…”

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confidence: 99%

Dexamethasone versus Dexmedetomidine as Adjuvants in Ultrasound Popliteal Sciatic Nerve Block for Hallux Valgus Surgery: A Mono-Centric Retrospective Comparative Study

Coviello,

Iacovazzo,

Cirillo

et al. 2024

DDDT

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Background and Aim Ultrasound popliteal sciatic nerve block (UPSNB) is commonly performed in foot and ankle surgery. This study aims to assess the use of dexmedetomidine and dexamethasone as adjuvants in UPSNB for hallux valgus (HV) surgery, comparing their efficacy in producing motor and sensory block and controlling postoperative pain. The adverse event rate was also evaluated. Methods This mono-centric retrospective study included 62 adult patients undergoing HV surgery: 30 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg and dexamethasone 4 mg (Group 1), whereas 32 patients received lidocaine 2% 200 mg, ropivacaine 0.5% 50 mg, and dexmedetomidine 1 mcg/Kg (Group 2). At first, the visual analogue scale (VAS) was evaluated after 48 hours. The other outcomes were time to motor block regression, evaluation of the first analgesic drug intake, analgesic effect, adverse effects (hemodynamic disorders, postoperative nausea and vomiting (PONV)) and patient satisfaction. The continuous data were analyzed with student’s t- test and the continuous one with χ 2 . Statistical significance was set at a p-value lower than 0.05. Results No significant difference was found in VAS after 48 hours (4.5 ± 1.6 vs 4.7 ± 1.7, p = 0.621) to motor block regression (18.9 ± 6.0 vs 18.7 ± 6, p = 0.922). The number of patients that took their first analgesic drug in the first 48 h (p = 0.947 at 6 hours; p = 0.421 at 12 hours; p = 0.122 at 24 hours and p = 0.333 at 48 hours) were not significant. A low and similar incidence of intraoperative hemodynamic disorders was recorded in both groups (hypotension p = 0.593; bradycardia p = 0.881). Neither PONV nor other complication was found. Patients in Group 1 reported a lower degree of interference with sleep (p = 0.001), less interference with daily activities (P = 0.002) and with the affective sphere (P = 0.015) along with a more satisfactory postoperative pain management (p < 0.001) as compared to Group 2. Conclusion No significant differences were observed in the duration of motor and sensory blockade between patients in both groups. Additionally, both groups showed good pain control with a low rate of adverse effects, even if there was no clinical difference between the groups. However, patients who received dexamethasone reported experiencing less interference with their sleep, daily activities and overall emotional well-being, and overall pain control.

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