Sciatic Nerve Blocks With or Without Femoral Block Versus Spinal Anaesthesia in Patients Undergoing Diabetic Foot Surgery
Condition: Diabetic Foot
MeSH terms: Diabetic Foot
Study type: Interventional

Summary: 
      Background:

      Dysautonomia refers to the abnormal function of the autonomic nervous system including
      sympathetic and parasympathetic nervous system. Diabetes mellitus causes secondary
      dysautonomias (1). The Survey of Autonomic Symptoms (SAS) is a simple and validated tool to
      assess the presence and severity of autonomic symptoms (2).

      Diabetic patients also suffer from chronic neuropathic pain. After amputation surgeries, up
      to 78% of these patients may develop post surgical neuropathic pain (3). The self-report
      version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) is
      validated as a diagnostic tool to assess patients with neuropathic pain (4). This scale will
      be used to assess if there is any changes in the pain experienced after diabetic foot
      surgery.

      Currently, both spinal anaesthesia (SAB) and ultrasound guided femoral and sciatic peripheral
      nerve blocks (FSNB) are acceptable anaesthesia for dysautonomic diabetic patients with
      diabetic foot ulcer going for wound debridement, Ray's amputation and below knee amputation
      (5)

      Many studies have compared multiple perioperative parameters of patients undergoing lower
      limb surgery under peripheral nerve blocks versus spinal anaesthesia. These parameters
      include preparation time, anaesthetic complications (e.g. hypotension, nausea and vomiting,
      post-dural puncture headache, urinary retention), patient satisfaction and postoperative pain
      control (6,7,8).

      The investigators want to study if patients with dysautonomia have a different haemodynamic
      response to spinal anaesthesia or peripheral nerve blockade changes compared to patients with
      normal autonomic function.

      Secondarily, the investigators would also study if there is a difference in post operative
      pain control as well as incidence in chronic pain in patients who receive spinal anaesthesia
      versus peripheral nerve blockade.
    

Detailed description: 
      Dysautonomia refers to the abnormal function of the autonomic nervous system including
      sympathetic and parasympathetic nervous system. Diabetes mellitus causes secondary
      dysautonomias (1). The Survey of Autonomic Symptoms (SAS) is a simple and validated tool to
      assess the presence and severity of autonomic symptoms (2).

      Diabetic patients also suffer from chronic neuropathic pain. After amputation surgeries, up
      to 78% of these patients may develop post surgical neuropathic pain (3). The self-report
      version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) is
      validated as a diagnostic tool to assess patients with neuropathic pain (4). This scale will
      be used to assess if there is any changes in the pain experienced after diabetic foot
      surgery.

      Currently, both spinal anaesthesia (SAB) and ultrasound guided femoral and/or sciatic
      peripheral nerve blocks (FSNB) are acceptable anaesthesia for dysautonomic diabetic patients
      with diabetic foot ulcer going for wound debridement, Ray's amputation and below knee
      amputation (5)

      Many studies have compared multiple perioperative parameters of patients undergoing lower
      limb surgery under peripheral nerve blocks versus spinal anaesthesia. These parameters
      include preparation time, anaesthetic complications (e.g. hypotension, nausea and vomiting,
      post-dural puncture headache, urinary retention), patient satisfaction and postoperative pain
      control (6,7,8).

      The investigators want to study if patients with dysautonomia have a different haemodynamic
      response to spinal anaesthesia or peripheral nerve blockade changes compared to patients with
      normal autonomic function.

      Secondarily, the investigators would also study if there is a difference in post operative
      pain control as well as incidence in chronic pain in patients who receive spinal anaesthesia
      versus peripheral nerve blockade.
    

Intervention name(s): Sciatic with or without femoral block; Spinal anaesthesia
Intervention type(s): Procedure; Procedure
Intervention description(s): Sciatic with or without femoral block performed either with ultrasound and/or nerve stimulator on the patient with 3mg/kg of ropivacaine; Spinal anaesthesia with up to 3mls of 0.5% bupivacaine
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: femoral sciatic block spinal diabetic foot haemodynamic pain