November 2012

Can Midfoot Nerve Blocks Get Hallux Valgus Patients Back On Their Feet Quicker?

By Brian McCurdy, Senior Editor

In order to address possible pain after hallux valgus surgery, surgeons have used sciatic nerve blocks for anesthesia and post-op analgesics. However, a new study in the French journal Annales Françaises d’Anesthésie et de Réanimation notes that in a percutaneous approach to bunion surgery, a midfoot block may promote quicker postoperative ambulation.

   Researchers randomly assigned 40 patients, who were scheduled to have ambulatory percutaneous hallux valgus repair, to receive either foot infiltration via a midfoot block or a sciatic nerve block. Each block was 30 mL of ropivacaine 7.5%. Surgery occurred without sedation or additional analgesia. The study authors note that both groups received oral paracetamol/codeine and ketoprofene, and took tramadol if necessary. Researchers assessed their walking ability and pain scores for 48 postoperative hours.

   Researchers found pain scores were comparable in each group at rest and while walking, although the time to ambulation without assistance was significantly lower for patients in the midfoot block group at 3.8 ± 1.4 hours in comparison to 19.2 ± 9.5 hours for the sciatic nerve block group. The study authors argued that midfoot blocks were preferable due to the quicker ambulation.

   For post-op analgesia after hallux valgus surgery, Andrew Rice, DPM, prefers a preemptive Mayo block of the midfoot with local anesthesia, which he often combines with sedation. Additionally, he will frequently provide a block of the midfoot or Mayo block at the completion of surgery, prior to bandaging, with long acting bupivacaine 0.5%. Similarly, Jesse Burks, DPM, will use a Mayo-type block for a distal or shaft osteotomy. He will employ more of a localized block for a proximal osteotomy or a Lapidus procedure, but will typically employ a true ankle block as well.

   Dr. Burks has used a sciatic block but does not use it routinely. He has found that a more proximal block will usually extend the “pain-free” period but has the disadvantage of limiting post-op ambulation. Usually, Dr. Burks takes advantage of this if he plans on admitting the patient following surgery, usually when the patient is having more extensive procedures than an isolated bunion correction. Dr. Rice does not use a sciatic block for patients undergoing bunion procedures. A midfoot or Mayo block of the first metatarsal and toe would be effective for patients having percutaneous hallux valgus repair, according to Dr. Rice, an Assistant Clinical Professor in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine.

   Dr. Burks agrees. “Anytime a patient retains mobility — as soon after surgery as possible — it just seems his or her post-op recovery is easier,” says Dr. Burks, a Fellow of the American College of Foot and Ankle Surgeons who practices in Little Rock, Ark.

Can Cherries Lower The Risk Of Gout Attacks?

By Danielle Chicano, Editorial Associate

A new study in Arthritis & Rheumatism found that patients with gout who consumed cherries or cherry extract over a two-day period showed a 35 percent lower risk of gout attacks in comparison to those who did not eat the fruit.

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