Abstract

Background: The last decade there has been an exponential increase in opioid-related deaths in the United States. This increase has been proven to be correlated with the high prescribing rates of strong opioids, such as morphine and oxycodone. The current research setup evaluated the feasibility of adequate peri-operative pain control in hallux valgus surgery with the combination of single dose popliteal nerve block plus one-time application of a transdermal fentanyl patch. Methods: A prospective observational study was conducted on 100 patients undergoing corrective osteotomy of the first metatarsal due to hallux valgus. A transdermal fentanyl patch (<70 kg 12 µg/h, >70 kg 24 µg/h) was applied on the upper arm one hour prior to surgery. Surgery was performed after ultrasound-guided popliteal nerve block. Patients filled in questionnaires between 6-72 hours after surgery to evaluate pain (Visual Analogue Scale), nausea (Post-Operative Nausea Vomiting-score), activity (activity and ambulation score) and intake of pain medication. Results: Minimum and maximum mean perioperative pain was 0.46 (SD 1.47) (6 h post-operative) and 3.94 (SD 2.76) (36 h post-operative), respectively on the Visual Analogue Scale. After discharge, 2% of patients required additional analgesia with strong opioids such as oxycodone. 64% of patients had less pain than expected prior to surgery. At 24-hour and 36-hour postoperatively, nausea was noted in 35% and 23% of patients, respectively. Conclusions: The one-time use of a weight-adjusted dose of transdermal fentanyl patch combined with single dose ultrasoundguided nerve block can be efficient when part of a multimodal analgesia approach to treat post-operative pain after hallux valgus surgery.

Keywords: Forefoot surgery; Opioid abuse; Opioid crisis; Pain management; Peri-operative analgesia