Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France; Department of Anatomy, Lille University School of Medicine, Lille, France.
Anesthesiology. 2024 Nov 1;141(5):891-903. doi: 10.1097/ALN.0000000000005180.
Walking ability is a key factor in enhanced recovery after foot ambulatory surgery. Plantar compartment block offers an analgesic alternative to popliteal sciatic nerve block (PSNB) for hallux valgus surgery. The objective of this study was to compare these two regional anesthesia strategies on patients' ability to recover a painless unaided walk.
This prospective double-blinded (patient; observing anesthesiologist) randomized study compared patients scheduled for hallux valgus surgery receiving PSNB with 1% mepivacaine, then combined plantar and peroneal nerve blocks (plantar compartment block [PCB] group) with ropivacaine 0.5% and dexamethasone, or PSNB with ropivacaine 0.5% and dexamethasone (control group). The primary outcome was the patient's ability to walk unaided 6 h after PSNB. The test was performed on a GAITRite, spatio-temporal gait analysis mat. For 3 days, the number of patient steps, pain levels, rescue analgesics, patient's experience, and adverse events were assessed.
Sixty patients were included and 59 were analyzed. The number of patients walking unaided on the GAITRite mat was significantly higher in the PCB group (21 of 30, 70%) than in the control group (4 of 29, 13.8%; P < 0.001). Gait quality using the Functional Ambulation Profile score was 63 ± 13.6 in the PCB group and 49.5 ± 4.7 in the control group (P < 0.001). Median time to free ambulation at home was significantly lower in the PCB group (9 h [8.2 to 11.8]) than in the control group (33.5 h [24 to 47]; P < 0.001). Postoperative pain did not differ between the groups (β = -0.41 [-1.78 to 0.95]; P = 0.548). The number of steps on day 3, the time of first rescue analgesic, the number of patients using rescue analgesia, consumption of morphine, and patient's experience did not differ between the groups.
PCB decreased the time to return to unaided walking, with improved gait, compared with PSNB, improving effective analgesia and low consumption of rescue analgesics. This innovative regional anesthesia strategy enhanced recovery after surgery.
步行能力是足部步行手术后快速康复的关键因素。足底间隔阻滞为踇外翻手术提供了一种替代隐神经-坐骨神经阻滞（PSNB）的镇痛方法。本研究的目的是比较这两种区域麻醉策略对患者无痛、独立行走能力的影响。
这是一项前瞻性、双盲（患者；观察麻醉师）随机研究，比较了接受 1%甲哌卡因 PSNB 联合足底和腓浅神经阻滞（足底间隔阻滞[PCB]组）与接受 0.5%罗哌卡因和地塞米松 PSNB（对照组）的患者。主要结局是 PSNB 后 6 小时患者独立行走的能力。通过 GAITRite 时空步态分析垫进行测试。在 3 天内评估患者的步数、疼痛程度、解救性镇痛药物的使用、患者体验和不良事件。
共纳入 60 例患者，59 例患者纳入分析。在 PCB 组，有 21 例（30 例中的 70%）患者在 GAITRite 垫上独立行走，明显高于对照组（29 例中的 4 例，13.8%；P<0.001）。使用功能性步行能力评分，PCB 组为 63±13.6，对照组为 49.5±4.7（P<0.001）。PCB 组在家中自由活动的中位时间（9 h[8.2 至 11.8]）明显短于对照组（33.5 h[24 至 47]；P<0.001）。两组术后疼痛无差异（β=-0.41[-1.78 至 0.95]；P=0.548）。两组第 3 天的步数、首次解救性镇痛药物的时间、使用解救性镇痛药物的患者数量、吗啡消耗量和患者体验均无差异。
与 PSNB 相比，PCB 可减少无痛独立行走的时间，改善步态，同时保持有效镇痛和低解救性镇痛药物消耗。这种创新的区域麻醉策略可促进术后快速康复。
