Improving postoperative analgesia in hallux valgus surgery: oral opioids suppression by addition of a single transdermal fentanyl patch: a prospective evaluation

Abstract

The last decade there is an exponential increase in opioid related deaths. This is proven to be correlated with the rising medical prescription rates of strong opioids. We investigated whether pain after hallux valgus surgery under popliteal nerve block could be adequately controlled without the prescription of oral opioids, with a single transdermal fentanyl patch. In this prospective observational study with 100 patients undergoing corrective first metatarsal osteotomies we prospectively investigated the adverse effects and need for extra pain medication. The transdermal fentanyl patch was applied one hour before surgery, prior to the ultrasound guided popliteal nerve block. Patients filled out a questionnaire every 6 hours to evaluate the pain [VAS-score], nausea [PONV-score], activity [acivity and ambulation score] and the intake of extra medication. Postoperative pain was well controlled [Mean VAS 2,53]. The maximum mean VAS score [3.93] was recorded 36 hours postoperatively. 63.8% of patients had less pain than expected. No major adverse effects were reported by the patients. Nausea was mainly mild and the majority of patients reported ‘no effect’ or ‘sometimes’ effect on daily activities. In an era where surgeons need to be aware of the threat of overuse of strong opioids, the use of a single transdermal fentanyl patch in combination with an ultrasound guided nerve block can be a good alternative in hallux valgus surgery. The use of the patch seems to obviate the need for oral opioids after discharge. Nausea and vomiting were a concern – as expected –, but only at 24 and 36 hours. On the other hand nausea did not seem to affect activity, as there was a gradual increase in activity score over time.