Ultrasound-guided single dose injection of 0.5% levobupivacaine or 0.5% ropivacaine for a popliteal fossa nerve block in unilateral hallux valgus surgery

Objective: To compare the perioperative analgesic efficacy of 0.5% levobupivacaine and 0.5% ropivacaine injected in a single dose to block the tibial and peroneal nerves for surgery using a posterior (popliteal fossa) approach.

Methods: Prospective randomized trial in patients undergoing hallux valgus surgery; anesthesia was provided by blocking nerves in the popliteal fossa with either 0.5% levobupivacaine or 0.5% ropivacaine. Variables studied were times until anesthetic block onset and reversal, need for additional sedation or peripheral block anesthetic, course of postoperative pain at 12, 24 and 48 hours and at 7 days, nighttime rest, need for additional analgesia, and patient satisfaction.

Results: Forty-six patients were enrolled. Times until onset of the sensory and motor blocks were similar in the 2 groups. For 57.1% of the patients, the sensory and motor block lasted 24 hours after surgery, with no between-group differences. The levobupivacaine group had less pain at rest 24 hours after surgery (mean [SD] visual analog scale score of 0.16 [0375] vs. 1.17 [1.88] in the ropivacaine group; P < .05). No patient reported severe pain or required additional analgesics. None were readmitted. More than 80% rested well at night. No between-group differences were observed.

Conclusions: The use of a single dose of either levobupivacaine or ropivacaine to provide anesthesia for a popliteal approach to hallux valgus surgery is effective for controlling postoperative pain.