Bimalleolar Fractures of the Ankle., Post Operative Analgesia Duration., Saphenous Nerve Block., Sciatic Nerve Block.
Conditions
Keywords
local anaesthesia, analgesia, bupivacaine, lidocaine, clonidine, sciatic nerve, saphenous nerve
Brief summary
Clonidine as an adjuvant to local anaesthetics prolongs the postoperative analgesia. It is predominantly an alpha 2 agonist, but does have some alpha 1 activity. Clonidine alone produces analgesia. When administered centrally its effects are predominantly due to its alpha 2 activity. When administered peripherally it prolongs the analgesia through its vasoconstrictor effects and by reducing the clearance of local anaesthetic. Another possibility is that it prolongs analgesia of peripheral nerve blocks due to a hyperpolarisation current .Clonidine has been used successfully both for upper and lower limb blocks. Studies of clonidine for lower limb blocks have produced equivocal results . A major concern with the lower limb blocks is the risk of falls associated with prolonged motor blockade during early mobilisation. Clonidine has been shown to intensify and prolong the motor blockade produced by long acting local anaesthetics. Lidocaine when used in combination with clonidine can increase the duration of analgesia to 8-18 hrs. Greater doses of clonidine are associated with longer analgesia but with more side effects. Clonidine in a dose of 90 mcg administered with local anaesthetics can produce analgesia for up to 10 hrs with minimal side effects. The aim of this study is to compare lidocaine 2% + clonidine 1.5mcg/kg with bupivacaine alone in terms of block selectivity for combined sciatic -saphenous nerve block in patients under going semi elective foot/ankle procedures.
Interventions
DRUGBupivacaine
DRUGLidocaine
Sponsors
Cork University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* ASA 1-3 patients scheduled to undergo semi elective ankle/foot surgery with regional anaesthesia will be recruited.
Exclusion criteria
* patient refusal, * allergy to local anaesthetics, * coagulopathy, * malignancy or infection at the block performance site, * significant peripheral neuropathy or neurologic disorder of the lower extremity or any other contraindication to sciatic and saphenous nerve block, * pregnancy, * history of alcohol or drug dependency/abuse (defined as \>40 IU/week), * a history of significant cognitive or psychiatric disorder that may affect patient assessment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of postoperative sensory and motor block. | 36 hours. | Postoperative analgesia/duration of block will be assessed at 4,6 8, 10,12,16 hrs or until complete recovery of sensation to cold spray upto 36 hours. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Onset time of block. | every 5 minutes upto 40 minutes | After completion of the two blocks the effect will be assessed every 5 minutes for onset time defined as the time from withdrawal of needle (t0) to complete loss of sensation in the sensory dermatomes of both sciatic and saphenous nerve. The sensory level will be assessed on toes and forefoot due to post operative cast restricted access to full tibial and peroneal nerve dermatomes. Motor block assessment will carried out using bromage and modified bromage scale for tibial and peroneal nerve |
Countries
Ireland
Outcome results
None listed