Efficacy of Multimodal Analgesia in Foot and Ankle Surgery: A Prospective Randomized Controlled Trial

Research Type: Level 1 - Randomized controlled trial (RCT), Meta-analysis of randomized trials with homogeneous results Introduction/Purpose: Effective postoperative pain management is essential for optimizing recovery and patient outcomes following foot and ankle surgery. Traditional opioid-based analgesia is associated with adverse effects and the risk of dependency. Multimodal analgesia (MMA) has been introduced to enhance pain control while reducing opioid consumption. However, evidence supporting its efficacy in foot and ankle surgery remains limited. This study aims to evaluate the clinical outcomes of MMA compared to conventional analgesic approaches. Methods: This prospective, randomized controlled trial included patients undergoing foot and ankle surgery, who were randomly assigned to the control or intervention group. The control group received a preoperative sciatic nerve block (SNB) and continuous sciatic nerve block (CSNB), while the intervention group received SNB, CSNB, and multimodal analgesia. (MMA) The MMA protocol included preoperative NSAID administration, intraoperative steroid (dexamethasone 10 mg) use, immediate postoperative NSAID administration, cold pack application, and postoperative NSAID and gabapentin (300 mg) use. Postoperative pain was evaluated using the visual analog scale (VAS) at 2, 4, 6, 8, 10, 12, 24, 48, and 72 hours postoperatively, as well as at 2 and 6 weeks. Pain scores were also recorded at 2, 4, 6, 8, 10, 12, and 24 hours following CSNB catheter removal. Secondary outcomes included opioid consumption, rescue analgesic use, complications, and patient-reported satisfaction. Results: The intervention group showed significantly lower visual analog scale (VAS) pain scores compared to the control group at 8, 10, 12, 18, 24, and 48 hours postoperatively, as well as immediately following CSNB catheter removal (p < 0.05). Opioid consumption was also significantly lower in the intervention group at 12, 18, and 24 hours postoperatively, with no significant difference in the incidence of adverse events between groups (p < 0.05). Patient satisfaction was significantly higher in the intervention group (9.36 ± 0.26) than in the control group (8.07 ± 0.27) (p < 0.05). These findings indicate that multimodal analgesia provides superior postoperative pain control. Conclusion: Multimodal analgesia significantly improved postoperative pain control and patient satisfaction while reducing opioid consumption in foot and ankle surgery. These findings support the efficacy and safety of multimodal analgesia as an enhanced pain management strategy.