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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
TRIPLE
Enrollment
60
Ankle block will be performed prior to surgery under ultrasound guidance
Sciatic nerve block will be performed prior to surgery under ultrasound guidance
Centre Hospitalier Universitaire Vaudois and University of Lausanne
Lausanne, Canton of Vaud, Switzerland
Duration of analgesia
Time elapsed between block procedure and first iv request of morphine from PCA
Time frame: 24 hours after surgery
Total opioid consumption at 24h postoperatively
Total consumption of morphine from PCA at 24 postoperative hours
Time frame: 24 hours after surgery
Pain score at rest at 4 postoperative hours
Pain score (visual analog scale, 0 = minimum; 10 = maximum)
Time frame: 4 hours after surgery
Pain score on movement at 4 postoperative hours
Pain score (visual analog scale, 0 = minimum; 10 = maximum)
Time frame: 4 hours after surgery
Pain score at rest at 12 postoperative hours
Pain score (visual analog scale, 0 = minimum; 10 = maximum)
Time frame: 12 hours after surgery
Pain score on movement at 12 postoperative hours
Pain score (visual analog scale, 0 = minimum; 10 = maximum)
Time frame: 12 hours after surgery
Pain score at rest at 24 postoperative hours
Pain score (visual analog scale, 0 = minimum; 10 = maximum)
Time frame: 24 hours after surgery
Pain score on movement at 24 postoperative hours
Pain score (visual analog scale, 0 = minimum; 10 = maximum)
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Time frame: 24 hours after surgery
Block success rate
Success of block assessed by pinprick test
Time frame: 45 minutes after block procedure
Global patient satisfaction 48h after surgery
Patient satisfaction score (visual analog scale, 0 = minimum; 10 = maximum)
Time frame: 48 hours after surgery
Complications after block
Report of any intravascular injection or any sensory/motor anomalies
Time frame: 48 hours after surgery
Rate of neuropathic pain
Rate of patients describing neuropathic pain 4-6 weeks postoperatively
Time frame: 4-6 weeks postoperatively
Rate of paresthesia
Rate of patients complaining of paresthesia
Time frame: Up to 24 hours after block procedure
Block procedure time
Time from first ultrasound image to needle withdrawal
Time frame: Up to 10 minutes after ultrasound scanning