There are multiple anesthesia modalities for foot joint surgery. Anesthesia strategy is chosen by anesthesiologist’s experience and skills with consideration of complications and preoperative medication.
Early postoperative rehabilitation after rheumatoid foot surgeries is important to reduce postoperative complications.
Purpose of this study:
• We hypothesized that peripheral nerve blocks (PNB) has an advantage in pain control and feasibility of early rehabilitation after foot surgeries.
• Purpose of this study was to compare postoperative outcomes including the feasibility of postoperative early rehabilitation in patients treated with general anesthesia and postoperative intravenous continuous fentanyl (IV-Fentanyl-Group) or general anesthesia and peripheral nerve blocks (PNB-Group).
Study design: Chart review retrospective study
Patients: With the IRB approval, patients who underwent foot joint surgery in out rheumatoid center between 2014 and 2017 were retrospectively studied.
Inclusion criteria: Rheumatoid forefoot surgery, age > 20, general anesthesia.
Exclusion criteria: Epidural and Spinal anesthesia cases were excluded.
Study Groups: Patients were divided into two groups:
1. IV-Fentanyl-Group: General anesthesia + Postoperative continuous fentanyl infusion using a patient-controlled analgesia pump.
2. PNB-Group: General anesthesia + Single administration of PNB (combination of sciatic and femoral or saphenous nerve block).
Feasibility of walking training on the first postoperative day (POD) rehabilitation.
Time to the first pain rescue medication requested after the end of surgery (except PCA rescue doses)
Number of the pain rescue medication used during the first 3 POD
Incidence of postoperative nausea and vomiting (PONV)
Statistics: Nominal variables were compared using the chi-square test or the Fisher’s exact test. The time to the first use of pain relief medication was compared using the Log-rank test. • p < 0.05 was considered statistically signoficant.
DISCUSSION & CONCLUSIONS
The feasibility of walking training on the 1st POD was higher in PNB-Group. The main factor disturbing
rehabilitation in IV-fentanyl group was nausea, which is likely a side effect of continuous fentanyl administration.
Interestingly, PNB allowed a better postoperative pain control than continuous fentanyl in the early phase. Even with patient control iv-fentanyl system, the median first pain rescue request time was about 7 hours shorter than PNB group. When Intraoperative fentanyl dose was not enough to reach pain relief, post operative continuous injection was not effective and resulted in higher nausea incidence. Pain is the second reason of disturbing 1st POD rehabilitation in the IV-Fentanyl group.
With PNB, about 25 % of patients were unable to walk and half of them developed dorsiflexion weakness. The choice of local anesthetics and doses of PNB is the key factor to improve the feasibility of rehabilitation after PNB.
In conclusion, this study showed that PNB has a significant advantage in early rehabilitation, could enhance the postoperative activity and contributes to reduce the incidence PONV in rheumatoid forefoot surgery patients.