Pain, Postoperative
Conditions
Brief summary
Pain after forefoot surgery can be important and regional anesthesia plays a crucial role in post-operative pain control. Several techniques can be used to achieve surgical anesthesia as well as postoperative analgesia. Of those techniques the ankle block and sciatic nerve block at the popliteal fossa are the most common. The primary goal of this study is thus to compare the analgesic duration of these two types of blocks for patients undergoing forefoot surgery.
Detailed description
Patients scheduled for unilateral forefoot surgery, aged over 18 years old and ASA status I-III without any contra-indications for regional anesthesia will be enrolled. After a standard randomisation, patients will be allocated in either of two groups : ankle block or sciatic nerve block at the popliteal fossa. In both groups the patients will have a multimodal analgesic regimen followed by a patient-controlled-analgesia (PCA) of morphine. The primary endpoint is the analgesic duration, defined by the time between the end of the block procedure and the first IV request of morphine from a PCA.
Interventions
PROCEDUREAnkle Block
Ankle block will be performed prior to surgery under ultrasound guidance
PROCEDURESciatic nerve block
Sciatic nerve block will be performed prior to surgery under ultrasound guidance
Sponsors
Centre Hospitalier Universitaire Vaudois
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who are going to undergo a unilateral forefoot surgery ; * ASA I-III ; * Aged 18 years or more; * Weighing at least 45 kg
Exclusion criteria
* Patient refusal and/or language/cognitive barrier * Pregnancy * Contra-indication for regional anesthesia * Opiate or alcohol dependency * Concomitant oncological disease with chemotherapy * Patients suffering from neuropathic pain
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of analgesia | 24 hours after surgery | Time elapsed between block procedure and first iv request of morphine from PCA |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of paresthesia | Up to 24 hours after block procedure | Rate of patients complaining of paresthesia |
| Block procedure time | Up to 10 minutes after ultrasound scanning | Time from first ultrasound image to needle withdrawal |
| Total opioid consumption at 24h postoperatively | 24 hours after surgery | Total consumption of morphine from PCA at 24 postoperative hours |
| Pain score at rest at 4 postoperative hours | 4 hours after surgery | Pain score (visual analog scale, 0 = minimum; 10 = maximum) |
| Pain score on movement at 4 postoperative hours | 4 hours after surgery | Pain score (visual analog scale, 0 = minimum; 10 = maximum) |
| Pain score at rest at 12 postoperative hours | 12 hours after surgery | Pain score (visual analog scale, 0 = minimum; 10 = maximum) |
| Rate of neuropathic pain | 4-6 weeks postoperatively | Rate of patients describing neuropathic pain 4-6 weeks postoperatively |
| Pain score at rest at 24 postoperative hours | 24 hours after surgery | Pain score (visual analog scale, 0 = minimum; 10 = maximum) |
| Pain score on movement at 24 postoperative hours | 24 hours after surgery | Pain score (visual analog scale, 0 = minimum; 10 = maximum) |
| Block success rate | 45 minutes after block procedure | Success of block assessed by pinprick test |
| Global patient satisfaction 48h after surgery | 48 hours after surgery | Patient satisfaction score (visual analog scale, 0 = minimum; 10 = maximum) |
| Complications after block | 48 hours after surgery | Report of any intravascular injection or any sensory/motor anomalies |
| Pain score on movement at 12 postoperative hours | 12 hours after surgery | Pain score (visual analog scale, 0 = minimum; 10 = maximum) |
Countries
Switzerland
Outcome results
None listed