Anti-edematous effect of escin lysinate in patients treated with corrective foot osteotomy

Introduction Surgical treatment of the forefoot deformities using corrective osteotomies can be associated with local reactions, manifested by postoperative swelling and pain. The factors can impact the timing and quality of early patient rehabilitation. The search for safe and effective means to relieve postoperative swelling and pain is essential in modern traumatology and orthopedics. The escin lysinate solution with angioprotective, anti-edematous, and analgesic effects, is considered as a pathogenetically substantiated approach.

The objective was to compare the efficacy and safety of escin lysinate used to reduce postoperative swelling and pain in patients after corrective osteotomies of the foot and the standard therapy and therapy supplemented with a short course of systemic glucocorticosteroids.

Material and methods A prospective randomized study included 30 patients (18–70 years) who underwent SCARF osteotomy of the first metatarsal bone, AKIN osteotomy, and/or Weil osteotomy. Patients were divided into three groups (10 individuals each) who underwent standard therapy (control); standard therapy + escin lysinate; standard therapy + dexamethasone. The severity of swelling of the limb, pain assessed with the visual analog scale (VAS), the need for nonsteroidal anti-inflammatory drugs (NSAIDs), the level of C-reactive protein, and the safety of therapy were dynamically evaluated.

Results The pain significantly reduced in the first three postoperative days in the escin lysinate group as compared to the control group with a reduced need for NSAIDs. A greater edema regression was observed at the metatarsal level at six weeks. Dynamics in pain was noted in the dexamethasone group at a short term with a less need for NSAIDs. No adverse reactions or clinically significant changes in laboratory parameters were recorded.

Discussion Postoperative edema was more evident in the foot as compared to other anatomical sites due to limited soft tissue volume and slow venous and lymphatic outflow from the distal extremities. In this context, medications that reduce vascular and tissue permeability play a role. Aescin lysinate was shown to demonstrate efficacy in neurosurgery and otolaryngology with the use being associated with reduceed edema and inflammation. In orthopedics and traumatology, the drug demonstrated angioprotective and analgesic potential in lower extremity injuries. Unlike systemic glucocorticosteroids such as dexamethasone having a pronounced but short-term anti-inflammatory effect and being associated with the risk of hyperglycemia, infections and bone loss, escin lysinate has a safety profile and can be considered as a pathogenetically justified agent for the control of postoperative inflammation and edema.

Conclusion A comparative evaluation of the adjuvant use of escin lysinate, standard therapy, and therapy supplemented with a short course of systemic glucocorticosteroids after corrective foot osteotomies demonstrated earlier pain relief and accelerated edema resolution with no risk of adverse reactions with escin lysinate. The drug can be considered an effective and safe addition to standard therapy, providing a more favorable early postoperative effect.

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