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.

Methods

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.

Conclusions

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.

Editor’s Perspective
What We Already Know about This Topic
  • The plantar compartment block is a new ultrasound-guided distal compartment block under the plantar fascia selectively targeting the medial and lateral plantar nerves while sparing heel sensitivity
  • The plantar compartment block offers an analgesic alternative to popliteal sciatic nerve block for hallux valgus surgery
  • The question of whether plantar compartment block enhances functional recovery when compared to popliteal sciatic nerve block remains unanswered
What This Article Tells Us That Is New
  • In this prospective randomized trial, both gait quality and median time to free ambulation was improved in patients with plantar compartment block when compared to those with popliteal sciatic nerve block following hallux valgus surgery