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Perioperative pain management and chronic postsurgical pain after elective foot and ankle surgery: a scoping review

  • Cierra Stiegelmar
  • Yibo Li
  • Lauren A. BeaupreEmail author
  • M. Elizabeth Pedersen
  • Derek Dillane
  • Martha Funabashi
Review Article/Brief Review
  • 172 Downloads

Abstract

Purpose

Chronic postsurgical pain (CPSP) can occur after elective mid/hindfoot and ankle surgery. Effective treatment approaches to prevent the development of CPSP in this population have not been extensively investigated. The impact of multimodal strategies to prevent CPSP following elective mid/hindfoot surgery is unknown because of both the heterogeneity of acute pain management and the lack of a recognized definition particular to this surgery. This review aimed to identify and evaluate current pain management strategies after elective mid/hindfoot and ankle surgery.

Sources

Manual and electronic searches (MEDLINE, Embase, and Cochrane Library) were conducted of literature published between 1990 and July 2017. Comparative studies of adults undergoing elective mid/hindfoot and ankle surgery were included. Two reviewers independently reviewed studies and assessed their methodological quality.

Principal findings

We found seven randomized-controlled trials meeting our inclusion criteria. Interventions focused on regional anesthesia techniques such as continuous popliteal sciatic and femoral nerve blockade. Participants were typically followed up to 48 hr postoperatively. Only one study assessed pain six months following elective mid/hindfoot and ankle surgery.

Conclusion

There is an overwhelming lack of evidence regarding CPSP and its management for patients undergoing elective mid/hindfoot and ankle surgery. The lack of a recognized and standard definition of CPSP after this group of surgeries precludes accurate and consistent evaluation.

Prise en charge de la douleur périopératoire et douleur chronique post-chirurgicale après une chirurgie non urgente du pied et de la cheville : une revue exploratoire

Résumé

Objectif

La douleur chronique post-chirurgicale (DCPC) peut survenir après une chirurgie non urgente de la section moyenne ou postérieure du pied, ou de la cheville. Les approches thérapeutiques efficaces pour prévenir l’apparition de DCPC dans cette population n’ont pas été examinées en profondeur. L’impact des stratégies multimodales pour prévenir la DCPC après une chirurgie non urgente de la section moyenne ou postérieure du pied est inconnu, tant en raison de l’hétérogénéité de la prise en charge de la douleur aiguë que du manque de définition reconnue spécifique à ce type de chirurgie. Ce compte-rendu a pour objectif d’identifier et d’évaluer les stratégies de prise en charge de la douleur actuellement utilisées après une chirurgie de la section moyenne ou postérieure du pied, ou de la cheville.

Sources

Des recherches manuelles et électroniques (MEDLINE, Embase, et Librairie Cochrane) ont été menées dans la littérature publiée entre 1990 et juillet 2017. Les études comparatives portant sur des adultes subissant une chirurgie non urgente de la section moyenne ou postérieure du pied ou de la cheville ont été incluses. Deux chercheurs ont indépendamment passé en revue les études et évalué leur qualité méthodologique.

Constatations principales

Nous avons trouvé sept études randomisées contrôlées respectant nos critères d’inclusion. Les interventions se concentraient sur des techniques d’anesthésie régionale tels que les blocs continus des nerfs sciatiques poplités et fémoraux. Les participants bénéficiaient en général d’un suivi jusqu’à 48 h après l’opération. Une seule étude a évalué la douleur six mois après une chirurgie non urgente de la section moyenne ou postérieure du pied ou de la cheville.

Conclusion

L’absence de données probantes est colossale en ce qui touche à la DCPC et à sa prise en charge pour les patients subissant une chirurgie non urgente de la partie moyenne ou postérieure et de la cheville. L’absence de définition normalisée et reconnue de la DCPC après ce type de chirurgie en exclut toute évaluation précise et cohérente.

Notes

Acknowledgements

This work was funded by the Alberta Health Services Surgery Strategic Clinical Network Studentship.

Disclosures

The authors have no commercial or non-commercial affiliations or any other associations that are or may be perceived to be a conflict of interest with the work presented.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Cierra Stiegelmar, M. Elizabeth PedersenDerek Dillane, and Martha Funabashi contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Lauren A. Beaupre contributed to the conception and design of the study. Yibo Li contributed to the acquisition of data. Lauren A. Beaupre and Yibo Li contributed to the analysis and interpretation of data.

Funding source

This work was funded by the Alberta Health Services Surgery Strategic Clinical Network Studentship.

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  • Cierra Stiegelmar
    • 1
  • Yibo Li
    • 2
  • Lauren A. Beaupre
    • 3
    Email author
  • M. Elizabeth Pedersen
    • 2
  • Derek Dillane
    • 4
  • Martha Funabashi
    • 5
    • 6
  1. 1.Faculty of ScienceUniversity of AlbertaEdmontonCanada
  2. 2.Department of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  3. 3.Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
  4. 4.Department of Anesthesiology and Pain MedicineUniversity of AlbertaEdmontonCanada
  5. 5.Collaborative Orthopaedic ResearchAlberta Health ServicesEdmontonCanada
  6. 6.Division of ResearchCanadian Memorial Chiropractic CollegeTorontoCanada

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