Pain management after hallux valgus repair surgery: an updated systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.
Academic Article
Overview
abstract
BACKGROUND: Hallux valgus repair surgery is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and update previous PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations for optimal pain management after hallux valgus repair surgery. METHODS: A systematic review utilising PROSPECT methodology was performed. Randomised controlled trials and systematic reviews published in the English language from January 1, 2019 to November 19, 2024 that assessed postoperative pain using analgesic, anaesthetic and surgical interventions were identified from CENTRAL, CINAHL, EMBASE, MEDLINE and Web of Science. RESULTS: Of the 375 articles identified, 17 RCTs and 7 systematic reviews/meta-analyses met our inclusion criteria (total: 24 publications). Interventions that improved postoperative pain relief included: paracetamol and nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors; dexamethasone; ankle block and, as an alternative, local anaesthetic wound infiltration; and minimally invasive surgery or percutaneous osteotomy. Insufficient evidence was found for the use of perineural magnesium or liposomal bupivacaine. No evidence was found for continuous popliteal sciatic nerve block or for the use of the plantar compartment nerve block. DISCUSSION: This review provides an update to the previous guidelines written by the PROSPECT group: there is one important change, minimally invasive surgery or percutaneous osteotomy is recommended over open osteotomy. Contemporary publications confirm the analgesic effects of ankle block as a first-choice modality with wound infiltration as an alternative. In addition, the analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a nonsteroidal anti-inflammatory drug or cyclooxygenase-2 selective inhibitor administered preoperatively or intra-operatively and continued postoperatively, along with systemic dexamethasone, and postoperative opioids for rescue analgesia.
