Pain Management of Hallux Valgus Surgery Is Achieved by Cocktail Therapy

Xie, Julin; Zhu, J.-Y.; Xu, Yiyin; Chen, Mengli; Chen, Haiyun; Yuan, Kaiping; Dong, Lin

doi:10.1155/2022/1084815

Cited by 2 publications

(3 citation statements)

References 28 publications

(31 reference statements)

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“…It is a complex three-dimensional deformity with different degrees of posterior foot, heel valgus angle, forefoot abduction, and midfoot varus. However, current classi cation methods do not observe at feet from a three-dimensional perspective [23,24]. At the same time, we also observed that the literature on paediatric exible at foot classi cation is relatively slow and less updated, so the literature available for reference in this study is relatively old.…”

Section: Discussionmentioning

confidence: 74%

The Thanks Classification, A New Method For Observing Paediatric Flexible Flatfoot

Zhu

Xie

2023

Preprint

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Background: Flatfoot shows the collapse or flattening of the medial longitudinal arch. 90% of emergency visits for foot pain in children are attributed to flatfoot. The diagnosis and classification of flexible flat feet in children is currently usually based on imaging or clinical measurements. Most of the existing classification methods of flexible flat feet in children are limited to single plane classification, without considering the influence of rotation and vision deformity. The aim of this research was to to summarize the classification of paediatric flexible flat foot and provide ideas for the treatment strategy of flat feet in children. Method： foot appearance photos and footscan insole system test data of 126 children with flexible flat feet (252 feet) from May 2022 to October 2022 were collected. foot-scan insole system test were used to detect flatfoot and posterior foot heel valgus angle. Based on foot appearance photographs and foot-scan insole system tests. According to whether the foot arch is flat, whether the forefoot with abduction, whether the posterior foot is eversion, and other factors, the “Thanks” the classification of children's flat foot is described. Type A: footscan insole system test results showed flat foot, posterior foot heel valgus angle less than 5°, and without abduction of the forefoot; Type B: footscan insole system test results showed flat foot, combined with abduction of the forefoot, posterior foot heel valgus angle less than 5°; Type C: footscan insole system tests results showed flat foot, posterior foot heel valgus angle more than 5°, and without abduction of forefoot; Type D: footscan insole system tests results showed flat foot, posterior foot heel valgus angle than 5°, and combine with abduction of forefoot. Three experienced foot and ankle surgeons and three rehabilitation doctors independently observed the appearance photos and footscan insole systemtests data of 126 patients with flexible flat feet, determined the flat foot type according to the “Thanks” classification, and randomly reclassified after 4 weeks interval. Finally, 45 cases were randomly selected for internal validation (2 junior orthopedic surgeons), and the intraclass correlation efficient value was used to assess the reliability. Result:The paediatric flexible flat feet were divided into 4 types according to the “Thanks” classification. The intraobserver and interobserver consistency of the Thanks classification was good (ICC 0.895 for foot and ankle surgeons, 0.918 for rehabilitation physicians; The first ICC of foot and ankle surgeons and rehabilitation doctors was 0.903, and the second ICC was 0.856. ICC of internal inspection is 0.873). Conclsion:The “Thanks” the classification of paediatric flexible flat foot is easily learned and accepted by both surgical and non-surgical physicians. It has a good significance for evaluating the functionality of the paediatric flexible flat foot and guiding the selection of the treatment.

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Section: Discussionmentioning

confidence: 74%

The Thanks Classification, A New Method For Observing Paediatric Flexible Flatfoot

Zhu

Xie

2023

Preprint

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“…Ropivacaine, a new longer acting local anesthetic, is the drug of choice for regional analgesia and postoperative pain management as it is not lipophilic and is more selective for motor nerves 23 . Ropivacaine exclusively blocks sensory-motor nerve separation at a very low concentration by blocking nerve excitation conduction with the reversible inhibition of sodium ion channels in the neuronal membrane 24 , making early rehabilitation possible. Local incision site ropivacaine infiltration has previously been reported to reduce postoperative wound pain 25 .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the effects of both drugs were the same between the 24 h and 72 h period 27 . LIA with a cocktail of betamethasone with ropivacaine and flubiprofen before wound closure extended the analgesic duration following hallux valgus surgery, compared to conventional surgical anesthesia 24 .…”

Section: Introductionmentioning

confidence: 99%

Pre-emptive infiltration with betamethasone and ropivacaine for postoperative pain in laminoplasty and laminectomy (PRE-EASE): a prospective randomized controlled trial

Shrestha,

Han,

Zhao

et al. 2023

International Journal of Surgery

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Background: Postoperative pain after laminoplasty and laminectomy occurs partially from local trauma of the paraspinal tissue. Finding a multimodal analgesic cocktail to enhance the duration and effect of local infiltration analgesia is crucial. Because of rapid onset and long duration of action of betamethasone, we hypothesized that, a preemptive multimodal infiltration regimen of betamethasone and ropivacaine reduces pain scores and opioid demand, and improves patient satisfaction following laminoplasty and laminectomy. Materials and methods: This prospective, randomized, open-label, blinded endpoint study was conducted between September 1, 2021 and June 3, 2022, and included patients between the ages of 18 to 64 scheduled for elective laminoplasty or laminectomy under general anesthesia, with American Society of Anesthesiologists classification I/II. 116 patients were randomly assigned to either the BR (Betamethasone-Ropivacaine) group or the R (Ropivacaine) group in a 1:1 ratio. Each group received preemptive infiltration of a total of 10 ml study solution into each level. Every 30 ml of study solution composed of 0.5 ml of Betamethasone plus 14.5 ml of saline and 15 ml of 1% ropivacaine for the BR group, and 15 ml of 1% ropivacaine added to 15 ml of saline for the R group. Infiltration of epidural space and intrathecal space were avoided and spinous process, transverse process, facet joints and lamina were injected, along with paravertebral muscles and subcutaneous tissue. Cumulative 48 hours postoperative butorphanol consumption via PCA (Patient-controlled analgesia) was the primary outcome. Intention-to-treat (ITT) principle was used for primary analysis. Results: Baseline characteristics were identical in both groups (P>0.05). The cumulative 48 hours postoperative butorphanol consumption via PCA was 3.0 1.4 mg in the BR group (n=58), and 7.1 1.2 mg in the R group (n=58) (P<0.001). Overall cumulative opioid demand was lower at different time intervals in the BR group (P<0.001), along with the estimated median time of first analgesia demand via PCA (3.3 hours in the BR group and 1.6 hours in the R group). Visual Analogue Scale (VAS) score at movement and rest were also significantly lower until 3 months and 6 weeks, respectively. No side effects or adverse events associated with the intervention were observed in this study. Conclusions: Preemptive analgesia with betamethasone and ropivacaine provides better postoperative pain management following laminoplasty and laminectomy, compared to ropivacaine alone. This is an effective technique worthy of further evaluation.

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Pain Management of Hallux Valgus Surgery Is Achieved by Cocktail Therapy

Cited by 2 publications

References 28 publications

The Thanks Classification, A New Method For Observing Paediatric Flexible Flatfoot

The Thanks Classification, A New Method For Observing Paediatric Flexible Flatfoot

Pre-emptive infiltration with betamethasone and ropivacaine for postoperative pain in laminoplasty and laminectomy (PRE-EASE): a prospective randomized controlled trial

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