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. 2020 Sep;45(9):702-708.
doi: 10.1136/rapm-2020-101479. Epub 2020 Jun 28.

PROSPECT guideline for hallux valgus repair surgery: a systematic review and procedure-specific postoperative pain management recommendations

Katarzyna Korwin-Kochanowska  1 , Arnaud Potié  2 , Kariem El-Boghdadly  3 , Narinder Rawal  4 , Girish Joshi  5 , Eric Albrecht  6 ; PROSPECT/ESRA Working Group Collaboration
Collaborators, Affiliations

PROSPECT guideline for hallux valgus repair surgery: a systematic review and procedure-specific postoperative pain management recommendations

Katarzyna Korwin-Kochanowska et al. Reg Anesth Pain Med. 2020 Sep.

Abstract

Hallux valgus repair is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and develop recommendations for optimal pain management after hallux valgus repair. A systematic review using PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomized controlled trials (RCTs) published in the English language from inception of database to December 2019 assessing postoperative pain using analgesic, anesthetic, and surgical interventions were identified from MEDLINE, EMBASE, and Cochrane Database, among others. Of the 836 RCTs identified, 55 RCTs and 1 systematic review met our inclusion criteria. Interventions that improved postoperative pain relief included paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors, systemic steroids, ankle block, and local anesthetic wound infiltration. Insufficient evidence was found for the use of gabapentinoids or wound infiltration with extended release bupivacaine or dexamethasone. Conflicting evidence was found for percutaneous chevron osteotomy. No evidence was found for homeopathic preparation, continuous local anesthetic wound infusion, clonidine and fentanyl as sciatic perineural adjuncts, bioabsorbable magnesium screws, and plaster slippers. No studies of sciatic nerve block met the inclusion criteria for PROSPECT methodology due to a wider scope of included surgical procedures or the lack of a control (no block) group. The analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a non-steroidal anti-inflammatory drug or cyclo-oxygenase-2 selective inhibitor administered preoperatively or intraoperatively and continued postoperatively, along with systemic steroids, and postoperative opioids for rescue analgesia.

Keywords: acute pain; ambulatory care; analgesia; pain management; pain, postoperative.

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Conflict of interest statement

Competing interests: EA is Associate Editor of the Regional Anesthesia & Pain Medicine and has received grants from the Swiss Academy for Anaesthesia Research (SACAR), Lausanne, Switzerland (50 000 CHF; no grant number attributed), from B Braun Medical (56 100 CHF; no grant number attributed), and from the Swiss National Science Foundation to support his clinical research (353 408 CHF; grant number: 32003B_169974/1). EA has also received honoraria from B Braun Medical and Sintetica UK. KE-B is Editor of Anaesthesia and has received educational, research, or consulting funding from Ambu, Fisher & Paykel Healthcare, and GE Healthcare. NR has received honoraria from Sintetica and Baxter. GJ has received honoraria from Baxter and Pacira Pharmaceuticals. In the past, PROSPECT has received unrestricted grants from Pfizer, New York, New York, USA, and Grunenthal, Aachen, Germany. MVdV has received honoraria from Sintetica, Grunenthal, Vifor Pharma, MSD, Nordic Pharma, Janssen Pharmaceuticals, Heron Therapeutics, CSL Behring, and Aquettant. EP-Z has received honoraria from Mundipharma, Grunenthal, MSD, Janssen-Cilag, Fresenius Kabi, and AcelRx.

Figures

Figure 1
Figure 1
PRISMA flow diagram of studies. FDA, Food and Drug Administration; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized controlled trial.
See this image and copyright information in PMC

References

    1. Torkki M, Malmivaara A, Seitsalo S, et al. . Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA 2001;285:2474–80. 10.1001/jama.285.19.2474 - DOI - PubMed
    1. Gerbershagen HJ, Aduckathil S, van Wijck AJM, et al. . Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013;118:934–44. 10.1097/ALN.0b013e31828866b3 - DOI - PubMed
    1. Wang J, Liu GT, Mayo HG, et al. . Pain management for elective foot and ankle surgery: a systematic review of randomized controlled trials. J Foot Ankle Surg 2015;54:625–35. 10.1053/j.jfas.2014.05.003 - DOI - PubMed
    1. Joshi GP, Van de Velde M, Kehlet H, et al. . Development of evidence-based recommendations for procedure-specific pain management: prospect methodology. Anaesthesia 2019;74:1298–304. 10.1111/anae.14776 - DOI - PMC - PubMed
    1. Myles PS, Myles DB, Galagher W, et al. . Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2017;118:424–9. 10.1093/bja/aew466 - DOI - PubMed

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