【罂粟摘要】足底筋膜阻滞可改善拇外翻手术后的恢复：一项随机、对照、双盲研究

步行能力是提高足部手术后恢复的关键因素。足底筋膜阻滞为拇外翻手术提供了一种替代腘窝坐骨神经阻滞（PSNB）的镇痛方法。本研究的目的是比较这两种区域麻醉策略对患者恢复无痛独立行走的能力。

这项前瞻性双盲随机研究比较了计划接受拇外翻手术的患者，这些患者接受1%甲哌卡因PSNB ，然后联合0.5%罗哌卡因和地塞米松足底和腓神经阻滞（足底筋膜阻滞[PCB]组），或0.5%罗哌卡因和地塞米松PSNB（对照组）。主要结果是患者在PSNB后6小时独立行走的能力。测试在GAITRite时空步态分析垫上进行。在3天内，评估患者步数、疼痛程度、急救镇痛剂、患者经历和不良事件。

纳入60例患者，分析了59例患者。PCB组中在GAITRite垫上独立行走的患者数量（21/30，70%）显著高于对照组（4/29，13.8%; P < 0.001）。步态质量采用功能性Ambassador Profile评分，PCB组为63 ± 13.6，对照组为49.5 ± 4.7（P < 0.001）。PCB组在家中自由活动的中位时间（9小时[8.2至11.8]）显著低于对照组（33.5小时[24至47]; P < 0.001）。两组术后疼痛无差异（β =-0.41 [-1.78至0.95]; P = 0.548）。第3天的步数、第一次使用急救镇痛剂的时间、使用急救镇痛剂的患者数量、吗啡消耗量和患者经历在两组之间没有差异。

与PSNB相比，PCB缩短了恢复独立行走的时间，步态得到改善，改善了有效镇痛和低消耗的急救镇痛药。这种创新的区域麻醉策略增强了手术后的恢复。

原始文献来源：Swisser,F. , Brethe,Y. , Choquet,O. , Herteleer,M. , Bernard,N. , Laffont,I. , Bringuier,S. ,& Capdevila , X.(2024).Plantar Compartment Block Improves Enhanced Recovery after Hallux Valgus Surgery: A Randomized, Comparative, Double-blind Study.Anesthesiology,141(5),891-903.https://doi.org/10.1097/ALN.0000000000005180

Plantar Compartment Block Improves Enhanced Recovery after Hallux Valgus Surgery: A Randomized, Comparative,

Double-blind Study

Abstract

Background: Walking ability is a key factor in enhanced recovery after foot ambulatory surgery. Plantar compartment block offers an analgesic alternative to popliteal sciatic nerve block (PSNB) for hallux valgus surgery. The objective of this study was to compare these two regional anesthesia strategies on patients’ ability to recover a painless unaided walk.

Method:This prospective double-blinded (patient; observing anesthesiologist) randomized study compared patients scheduled for hallux valgus surgery receiving PSNB with 1% mepivacaine, then combined plantar and peroneal nerve blocks (plantar compartment block [PCB] group) with ropivacaine 0.5% and dexamethasone, or PSNB with ropivacaine 0.5% and dexamethasone (control group). The primary outcome was the patient’s ability to walk unaided 6 h after PSNB. The test was performed on a GAITRite, spatio-temporal gait analysis mat. For 3 days, the number of patient steps, pain levels, rescue analgesics, patient’s experience, and adverse events were assessed.

Results:Sixty patients were included and 59 were analyzed. The number of patients walking unaided on the GAITRite mat was significantly higher in the PCB group (21 of 30, 70%) than in the control group (4 of 29, 13.8%;P < 0.001). Gait quality using the Functional Ambulation Profile score was 63 ± 13.6 in the PCB group and 49.5 ± 4.7 in the control group (P < 0.001).Median time to free ambulation at home was significantly lower in the PCB group (9 h [8.2 to 11.8]) than in the control group (33.5 h [24 to 47]; P <0.001). Postoperative pain did not differ between the groups (β = −0.41[−1.78 to 0.95]; P = 0.548). The number of steps on day 3, the time of first rescue analgesic, the number of patients using rescue analgesia, consumption of morphine, and patient’s experience did not differ between the groups.

Conclusion:PCB decreased the time to return to unaided walking, with improved gait, compared with PSNB, improving effective analgesia and low consumption of rescue analgesics. This innovative regional anesthesia strategy enhanced recovery after surgery.