The benefits of ambulatory surgery are widely known and justify the progressive increase in surgeries performed in this setting, in Portugal >60%. However pain control after discharge is mandatory. The growing use of ultrasound blocks(USb) reflect its importance as part of an opioid-sparing strategy with better outcomes. Several analgesic schemes have been adopted in hallux valgus surgery(HVs) such as popliteal USb, which despite is an effective alternative, it’s not absent of risks, like gait impairment by motor block caused. The USb of the superficial peroneal(SP), deep peroneal(DP) and posterior tibial(PT) allow consistent and lasting analgesia. The objective of this study is verify if the USb of the SP, DP and PT is an effective and safe option, evaluating the analgesic efficacy in the first 24h postop and satisfaction of the patients submitted to ambulatory HVs
A retrospective analysis of patients underwent HVs between January and November 2017, under general balanced anaesthesia (induction: fentanyl 3mcg/kg and propofol 2mg/kg, maintenance: desflurane) combined with USb SP, DP and PT (total 10ml of ropivacaine 0.75%). Analgesia was assured with paracetamol and ketorolac, prophylaxis of PONV was performed with dexamethasone and ondansetron. The ambulatory analgesia was paracetamol 3id, tramadol 3id and ibuprofen 3id. Patients were evaluated until discharge and contacted by telephone on the D2 postop. Pain was evaluated in the first 24hours (numeric pain scale), satisfaction of pain control and overall satisfaction (Likert scale 4points)
23 patients underwent HVs in the outpatient setting under the described anaesthetic technique, of which 10 responded to the postop survey. There were no complications or need for rescue analgesia in the PACU. 70% of patient were ASA 2 with a mean age of 56 years. Data analysis revealed a mean maximum pain score of 3(0-10) in the first 24hours. The degree of satisfaction with pain control was on average 3.9(0-4). The overall satisfaction level was 4(0-4) and when asked all patients would choose for ambulatory surgery again
The USb of SP, DP and PT seems to be an effective analgesic alternative. It’s a distal block, less likely to complicate and not associated with motor block, which leads to high satisfaction rates among patients undergoing ambulatory HVs. However more studies will be needed to prove the promising results presented and define the ideal analgesic strategy

03 / The impact of superficial peroneal, deep peroneal and posterior tibial ultrasound block on patients' satisfaction undergoing hallux valgus surgery in ambulatory