In 60 patients receiving elective
hallux valgus repair, we compared the efficacy of continuous popliteal sciatic nerve block produced with 0.2%
ropivacaine (n = 20), 0.2%
levobupivacaine (n = 20), or 0.125%
levobupivacaine (n = 20) infused with a patient-controlled system starting 3 h after a 30-mL bolus of the 0.5% concentration of the study
drug and for 48 h (baseline infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min; maximum incremental doses per hour, 3). No differences were reported in the intraoperative efficacy of the
nerve block. The degree of
pain was similar in the three groups throughout the study period, both at rest and during motion. Total consumption of
local anesthetic solution during the first 24 h was 148 mL (range, 144-228 mL) with 0.2%
ropivacaine, 150 mL (range, 144-200 mL) with 0.2%
levobupivacaine, and 148 mL (range, 144-164 mL) with 0.125%
levobupivacaine (P = 0.59). The volume of
local anesthetic consumed during the second postoperative day was 150 mL (range, 144-164 mL) with 0.2%
ropivacaine, 154 mL (range, 144-176 mL) with 0.2%
levobupivacaine, and 151 mL (range, 144-216 mL) with 0.125%
levobupivacaine (P = 0.14). A smaller proportion of patients receiving 0.2%
levobupivacaine showed complete recovery of foot motor function as compared with 0.2%
ropivacaine and 0.125%
levobupivacaine, both at 24 h (35% vs 85% and 95%; P = 0.0005) and at 48 h (60% vs 100% and 100%; P = 0.001). We conclude that sciatic infusion with both 0.125% and 0.2%
levobupivacaine provides adequate postoperative
analgesia after
hallux valgus repair, clinically similar to that provided by 0.2%
ropivacaine; however, the 0.125% concentration is preferred if
early mobilization of the operated foot is required.