Long-Acting Narcotic Multimodal Anesthesia Versus Standard of Care Anesthesia for Hallux Valgus Patients…

Randomized trialThe Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons· Jul 2026

Long-Acting Narcotic Multimodal Anesthesia Versus Standard of Care Anesthesia for Hallux Valgus Patients Undergoing a Percutaneous Distal Metatarsal Osteotomy: A Multi-Center Randomized Controlled Trial.

Shayan Karimi, Dena Bakhsh, Lucy Luo … Marie Gdalevitch

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Foot & AnkleRandomized trialTreatmentQ2IF 1.6

Multimodal analgesia with long-acting tramadol cut short-acting narcotic pill use after surgery.

Long-Acting Narcotic Multimodal Anesthesia Versus Standard of Care Anesthesia for Hallux Valgus Patients Undergoing a Percutaneous Distal Metatarsal Osteotomy: A Multi-Center Randomized Controlled Trial.

Shayan Karimi … Marie Gdalevitch

The Journal of foot and ankle surgery · Jul 2026 · Q2 in Orthopedics

Background

Hallux valgus surgery often results in significant post-operative pain, requiring narcotics.

Purpose

This study investigates whether multimodal analgesia (acetaminophen, naproxen, and pregabalin) with the use of long-acting tramadol reduces the need for short-acting narcotics following minimally invasive hallux valgus surgery under regional ankle block anesthesia.

Methods

A total of 114 patients aged 18-70 with BMI ≤ 40 undergoing hallux valgus surgery were randomized into Experimental (Exp) and Standard (S) groups.

n = 114 patients

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Results

5.24

multimodal analgesia meant fewer opioid pills needed after surgery

n = 114 patients

More results

13.53 hydromorphone pills (54.12 MME) in the S group (p < 0.0005), however the Exp group consumed a higher overall MME.

Notably, of all patients in the study, 27.2% did not consume any short-acting narcotics post-operatively (43.1% in Exp group and 10.7% in S group).

More results

Pain scores at 24 and 48 hours were significantly less in the Exp group (p=0.001, p=0.012), but the difference was minimal and not clinically significant.

Steps and sleep were comparable between groups.

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Conclusion

Multimodal analgesia with long-acting narcotics in minimally invasive surgery was associated with reduced short-acting narcotic use, but higher overall MME compared to the standard protocol.

Long-Acting Narcotic Multimodal Anesthesia Versus Standard of Care Anesthesia for Hallux Valgus Patients Undergoing a Percutaneous Distal Metatarsal Osteotomy: A Multi-Center Randomized Controlled Trial.

Long-Acting Narcotic Multimodal Anesthesia Versus Standard of Care Anesthesia for Hallux Valgus Patients Undergoing a Percutaneous Distal Metatarsal Osteotomy: A Multi-Center Randomized Controlled Trial.

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