Comparison Between Ultrasonography-Guided Popliteal Sciatic Nerve Block and Spinal Anesthesia for Hallux Valgus Repair

Abstract

Background: We aimed to compare the efficacy, postoperative pain scores, adverse effects, additional analgesic requirements, and patient satisfaction scores of ultrasonography-guided sciatic nerve block by popliteal approach with spinal anesthesia for hallux valgus correction surgery. Methods: Sixty patients scheduled for hallux valgus correction surgery were enrolled in this prospective randomized study. Unilateral spinal block was performed on patients in the spinal anesthesia group. Popliteal block group patients received popliteal sciatic nerve block with guidance by both nerve stimulator and ultrasonography. Durations of anesthetic and operative interventions and time until the initiation of surgery were recorded for both groups. Pain magnitude of the patients at the 2nd, 4th, 6th, 12th, and 24th hours following anesthetic interventions were assessed with a visual analog scale (VAS). Adverse effects such as postoperative urinary retention and postdural puncture headache were recorded. Also, patient satisfaction was recorded. Patients were interviewed by phone for anesthetic and operative complications at 72 hours postoperatively. Results: Spinal anesthesia group patients exhibited hypotension, bradycardia, postdural puncture headache, and urinary retention rates of 6.6%, 3.3%, 10%, and 3.3%, respectively. Popliteal block group patients showed none of these adverse effects. Moreover, VAS scores of the patients at the 2nd, 4th, 6th, and 12th hours were significantly lower ( P < .001, P = .003, P < .001, P <.001, respectively), postoperative first analgesic requirement times were significantly longer ( P < .001), and pain satisfaction scores were significantly higher ( P < .001) in the popliteal block group. Conclusion: Given the complications related to spinal anesthesia and its insufficiency to maintain analgesia postoperatively, we believe the preferred anesthetic method should be peripheral nerve blocks for hallux valgus correction surgeries. Level of Evidence: Level I, randomized prospective study.