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164 Anaesthesia and postoperative analgesia for forefoot surgery – a review of our current practice at nottingham city hospital
  1. N Sadavarte1,
  2. T Chen2 and
  3. V Thanawala1
  1. 1Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2University of Nottingham Medical School, Nottingham, UK


Background and Aims Foot and ankle surgery are associated with moderate to severe pain which can influence the postoperative outcome. We performed an audit to review our practice for forefoot surgery at Nottingham City Hospital based on the anaesthesia and analgesia principles outlined in the recently published PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) guideline for Hallux Valgus repair surgery.1

Methods We performed a retrospective audit for patients who underwent forefoot surgery between 01/07/19 to 31/12/19. The data was collated from the Digital Health Records database, analysed in Microsoft Excel and presented at clinical governance meeting

Results A total of 102 patients underwent forefoot surgeries. Out of them, 68 patients had peripheral nerve blocks (PNBs) only, 30 had general anaesthetic alone or in combination with PNB or local anaesthetic infiltration (LAI) and 4 had only spinal anaesthetic. Ankle block was the most commonly performed PNB. Only 5% of patients received systemic paracetamol + nonsteroidal anti-inflammatory drugs (NSAIDs) and 26% received intraoperative dexamethasone. Discharge prescription were missing for 22% of the patients. Of those retrievable, 89% included an opioid to take home.

Conclusions As recommended in the guideline, the ankle block was PNB of choice. The majority of those who did not have an ankle block, had a popliteal sciatic nerve block and saphenous nerve bock or LAI. However, there is scope of improvement in the use of intraoperative multimodal analgesia with paracetamol, NSAIDs and dexamethasone and appropriate discharge prescription for effective postoperative pain management.

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