Plantar Compartment Block Versus Sciatic Block in Hallux Valgus Ambulatory Surgery
Condition: Anesthesia
MeSH terms: Hallux Valgus
Study type: Interventional

Summary: 
      Hallux valgus surgery is known as a painful surgery. Qualitative pain management is the key
      to successful early recovery and rehabilitation.

      Sciatic popliteal nerve block is widely used despite the risk of falling due to prolonged
      motor blockade.

      Plantar block combined with distal peroneal block may be a better analgesic option in order
      to provide fast track rehabilitation.

      This study aims to determine the quality of deambulation following hallux valgus surgery.

      Block quality, post operative pain, patient satisfaction and length of hospital stay will be
      compared in this study.

      Patients scheduled for ambulatory (hallux valgus) surgery under regional anaesthesia alone
      (without general anesthesia) will be recruited.

      Consenting patients will be randomized the day of surgery to one of those two groups :

        1. Short lasting sciatic nerve block (mepivacaine 1% 200mg) and long lasting plantar block
           (ropivacaine 0,5% 25mg + 2mg dexamethasone) with distal deep peroneal block (ropivacaine
           0,5% 2ml).

        2. Long lasting sciatic nerve block (ropivacaine 0,5% 100mg + 2mg dexamethasone)

      All patients will benefit from post operative analgesia including paracetamol, nonsteroidal
      antiinflammatory drugs intravenously.

      During PACU stay, pain will be assessed using the VAS (visual analogue scale) score, and
      analgesic IV consumption.

      Temporospatial gait analysis will be assessed with a GAITRITE system before the patient leave
      the hospital.

      Deambulation and walking ability will be evaluated at home postoperatively to day 3 using an
      acetimetry bracelet.

      Pain, postoperative analgesic requirement, sleep quality and overall patient satisfaction
      (EVAN-LR) will also be assessed during the first 3 postoperative days.
    

Detailed description: 
      Hallux valgus surgery is known as a painful surgery. Qualitative pain management is the key
      to successful early recovery and rehabilitation.

      Sciatic popliteal nerve block is widely used despite the risk of falling due to prolonged
      motor blockade.

      Plantar block combined with distal peroneal block may be a better analgesic option in order
      to provide fast track rehabilitation.

      This study aims to determine the quality of deambulation following hallux valgus surgery.

      Block quality, post operative pain, patient satisfaction and length of hospital stay will be
      compared in this study.

      Patients scheduled for ambulatory (hallux valgus) surgery under regional anaesthesia alone
      (without general anesthesia) will be recruited.

      Consenting patients will be randomized the day of surgery to one of those two groups :

        1. Short lasting sciatic nerve block (mepivacaine 1% 200mg) and long lasting plantar block
           (ropivacaine 0,5% 25mg + 2mg dexamethasone) with distal deep peroneal block (ropivacaine
           0,5% 2ml).

        2. Long lasting sciatic nerve block (ropivacaine 0,5% 100mg + 2mg dexamethasone)

      All patients will benefit from post operative analgesia including paracetamol, nonsteroidal
      antiinflammatory drugs intravenously.

      During PACU stay, pain will be assessed using the VAS (visual analogue scale) score, and
      analgesic IV consumption.

      Temporospatial gait analysis will be assessed with a GAITRITE system before the patient leave
      the hospital (6 hours after ALR).

      Deambulation and walking ability will be evaluated at home postoperatively to day 3 using an
      acetimetry bracelet.

      Pain, postoperative analgesic requirement, sleep quality and overall patient satisfaction
      (EVAN-LR) will also be assessed during the first 3 postoperative days.
    

Intervention name(s): PLANTAR BLOCK; Sciatic popliteal block
Intervention type(s): Procedure; Procedure
Intervention description(s): Sciatic popliteal block : patient in lateral position, injection of 20 ml of the mixture labelled " BLOC POPLITE " containing 20 ml of mepivacain 1% (200mg)
Plantar block 10 minutes later : patient in supine position. Medial midfoot injection of 5 ml of the mixture labelled " BLOC PLANTAIRE " containing 5 ml of Ropivacaine 0,5% (25mg) with 0,5 ml dexaméthasone (2mg)
Distal deep fibular block : patient in supine position, injection around the dorsal foot artery of 2 ml of the mixture labelled " BLOC FIBULAIRE " containing 2 ml of Ropivacaine 0,5% (10mg).; 1-Sciatic popliteal block : patient in lateral position, injection of 20 ml of the mixture labelled " BLOC POPLITE " containing 20 ml of ropivacaine 0,5% (100mg) with 2mg (0,5 ml) of dexamethasone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Other
Keywords: Anesthesia; plantar Block