Comparison of Popliteal Nerve Block and Combined Spinal-Local Infiltration Anesthesia in Hallux Valgus Surgery: A Randomized Clinical Trial.

Background: Early mobilization and adequate pain relief are important in hallux valgus surgery. The effect of anesthesia technique on post-operative mobility has not been well studied.

Purpose: In search for the anesthesia technique that allows best for early mobility, a prospective clinical trial was conducted to compare popliteal nerve block anesthesia with combined local infiltration anesthesia (LIA) and spinal anesthesia.

Study design: Randomized clinical trial METHODS: Thirty-three patients eligible for hallux valgus surgery were prospectively randomized to receive either LIA/spinal anesthesia (n=14) or popliteal nerve block anesthesia (n=17). Hallux valgus surgery was performed in a short stay clinical setting, facilitating data collection during an overnight stay. Patients were postoperatively mobilized both on the day of surgery, and the next day. The primary outcome was early postoperative mobility. Intra- and postoperative pain relief, and patient satisfaction were secondary outcomes.

Results: On the day of surgery, independent mobilization and weight-bearing ability of patients who received LIA/spinal anesthesia were significantly better (p=0.022, p=0.010), compared to patients receiving the popliteal nerve block. The next day, independent mobilization did not differ between the 2 groups, although the weight bearing ability was better in patients who received LIA/spinal anesthesia. No significant between-group differences were observed in intra- and postoperative pain. High satisfaction with the anesthetic technique was achieved in both groups.

Conclusion: LIA/spinal anesthesia was associated with earlier independent ambulation and weight-bearing, suggesting potential benefits for outpatient hallux valgus surgery. However, both popliteal nerve block anesthesia and LIA/spinal anesthesia are suitable for hallux valgus surgery, with adequate pain relief and high patient satisfaction.

Level of clinical evidence: Level 2.