Arthrosis, Arthritis
Conditions
Brief summary
The study investigates the effect of a ultrasound-guided subsartorial saphenous block on postoperative pain following major ankle and hind foot surgery.
Detailed description
Major ankle and hind foot surgery causes intense postoperative pain. Implementation of continuous sciatic catheters has been a great success in reducing postoperative pain following these operations, but despite an effective sciatic catheter patients still report moderate to severe pain from the anteromedial side of the ankle. According to cadaver dissection studies the saphenous nerve innervates the anterior and medial parts of the ankle and talonavicular joint, and even though a saphenous block is standard procedure in many departments of anesthesiology worldwide, scientific evidence regarding the effect of the saphenous block on postoperative pain is lacking. This study investigates the effect of a selective, ultrasound-guided subsartorial saphenous block on postoperative pain following major ankle and hind foot surgery.
Interventions
50 mg bupivacaine and 50 μg adrenalin
OTHERPlacebo
9 mg sodium chloride pr. ml (0,9 %)
Sponsors
University of Aarhus
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Elective ankle or hind foot surgery either: (1) total ankle arthroplasty, (2) ankle arthrodesis (3) subtalar arthrodesis or (4) triple arthrodesis * Age ≥ 18 * American Society of Anaesthesiology Classification I-III * Informed consent both orally and in writing after the patient has fully understood the protocol and its limitations.
Exclusion criteria
* Communication problems or dementia * Allergies to any medical product used in the study * Neuropathy of the sciatic or femoral nerve prior to the operation * Morbus Charcot-Marie-Tooth disease, diabetic neuropathy, peripheral vascular disease * Daily use of opioids * Coagulation disorders * Infection at the site of injection or systemic infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of patients who experience significant pain at rest (change from no significant pain to significant pain) | Arrival at the Perioperative Section (within 30 minutes after surgery) and at t = 30 min, t = 45 min, t = 60 min, t = 75 min, t = 90 min, t = 105 min, t = 120. The beginning of the observation period (t0) is the registered time for the end of surgery. | Pain scores evaluated using NRS (numeric rating scale). Significant pain is defined as NRS \> 3 from the anterior and/medial side of the ankle joint. In case of significant pain, patients receive a rescue saphenous block with 10 ml bupivacaine-adrenaline. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensory testing, infrapatellar branch (nociception is tested using a standardized Neuropen) | At the time point when the patients report a change to significant pain during the observation period. In case of no significant pain during the observation period, sensory testing is conducted at t = 120 min. | Test of nociceptive response in the cutaneous innervation area of the infrapatellar branch (branch of the saphenous nerve). The test is performed in an area from the medial femoral condyle to the midline between the apex of patella and tibial tuberosity. |
| Sensory testing, sciatic nerve (nociception is tested using a standardized Neuropen) | Sensory test is conducted at arrival at the Perioperative Section (within 30 minutes after surgery) | Test of nociceptive response in the sciatic cutaneous innervation area to confirm full sensory block of the sciatic nerve. |
Countries
Denmark
Outcome results
None listed