Therapeutic Efficacy of Modified Cocktail Analgesia After Minimally Invasive Chevron Osteotomy for Hallux Valgus: A Retrospective Case Series Study

Jiahe Liu,1,* Tao Zhang,1,2,* Zewen Wang,1 Ting He,1,2 Wanqi Xiong,1 Yan Cui,1 Zhenhao Li,1 Fan Yang,1 Baoyi Liu1 1Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, People’s Republic of China; 2Graduate School of Dalian Medical University, Dalian, Liaoning, People’s Republic of China*These authors contributed equally to this workCorrespondence: Baoyi Liu, Email [email protected]: To evaluate the efficacy of modified cocktail analgesia in relieving pain after minimally invasive chevron osteotomy for hallux valgus.Methods: A retrospective cohort study was conducted to analyze the clinical data of 90 patients with moderate to severe hallux valgus admitted to our hospital from January 2020 to December 2023. Based on the treatment method and the number of affected limbs, the patients were divided into three groups: the modified group (Imp) treated with minimally invasive chevron and Akin (MICA) osteotomy combined with modified cocktail therapy, the traditional group (Tro) treated with MICA osteotomy combined with conventional cocktail therapy, and the control group (NC) treated with MICA osteotomy alone without cocktail therapy. The visual analog scale (VAS) scores for ankle-foot pain from 6 hours preoperatively to 14 days postoperatively, the need for postoperative rescue analgesia, adverse reactions, and complications were observed and compared among the three groups.Results: There were no significant differences in basic conditions such as age and BMI among the three groups. It is in line with the epidemiological statistics of hallux valgus in terms of gender. The VAS scores at 6 hours and 1 day postoperatively were significantly lower in the modified group [(0.67± 0.60), (0.68± 0.59) respectively] compared to the traditional group [(0.82± 0.50), (0.78± 0.90) respectively] (P < 0.05). There were no statistically significant differences in VAS scores between groups at 6 hours preoperatively and 7 days and 14 days postoperatively (P > 0.05). Five patients (5.56%) in the modified group required postoperative rescue analgesia, which was significantly fewer than the 12 patients (13.33%) in the traditional group (P < 0.05).Conclusion: Based on the comprehensive statistical results and clinical significance, the modified cocktail therapy has certain clinical reference value in the short-term analgesia management after MICA. It is beneficial for the early postoperative rehabilitation functional exercise of patients and has a good safety effect. It can be used as an optional option for early postoperative pain control. However, it is necessary to objectively recognize the timeliness of its therapeutic advantages. Its long-term analgesic effect shows no significant clinical difference from the traditional cocktail therapy and the simple MICA procedure.Keywords: hallux valgus, cocktail analgesia, minimally osteotomy