Effect of Intraoperative Ankle Nerve Blocks on Postoperative Discharge in Patients Undergoing Orthopaedic Foot Surgery
Condition: Operative Incision
MeSH terms: Surgical Wound
Study type: Interventional

Summary: 
      Postoperative pain is an important clinical issue which negatively affects patient's
      satisfaction, delays discharge and repeated admission after discharge in orthopedic surgery.
      Peripheral nerve blocks are commonly used for postoperative analgesia as an adjunct to
      analgesic drugs. The aim of this study is to evaluate the effect of ankle blocks performed at
      the end of the surgery on postoperative discharge times, postoperativeanalgesia, patient's
      satisfaction, additional analgesic requirements, and complications in patients undergoing
      orthopedic foot surgery.
    

Detailed description: 
      After written informed consent obtained from patients, patients will be randomly assigned to
      placebo group (Group I) and block group (group II) using sealed envelope method. IV venous
      catheter will be inserted and saline or Ringer's Lactate solution will be infused to patients
      for prehydration.0.1-0.5 mg/kg midazolam will be given for premedication. After arriving into
      OR, the patients will be monitored with ECG, pulse oximetry and noninvasive blood pressure.
      Anesthesia will be induced using 2-2,5 mg/kg propofol, 1-2 mcg/kg fentanyl, 10 mg-20 mg
      rocuronium, and a proper size laryngeal mask airway (LMA) will be placed to secure the
      airway. The lungs will be ventilated with a mixture of 50% air + 50% oxygen. Propofol and
      remifentanil based total intravenous anesthesia (TIVA) technique will be used for the
      maintenance of anesthesia. Tenoxicam 20 mg will be used for preemptive analgesia, cefazolin
      25 mg/kg for antibiotic prophylaxis, ranitidine 50 mg for gastric protection, and
      metoclopramide 10 mg for postoperative nausea and vomiting. Acetaminophen 10-15 mg/kg IV will
      be given for postoperative analgesia at the time of wound closure.

      At the end of the operation, an ankle nerve block will be performed in group II patient using
      a mixture of 2%lidocaine and 10 ml of bupivacaine and the same amount placebo in group I
      (placebo group) under the guidance of peripheral nerve stimulator. The anesthesia will be
      discontinued and LMA will be removed. The patients will be transferred from postoperative
      care unit to the ward after they were eligible for discharge according to modified Aldrete
      scoring system.

      Postoperative analgesia will be evaluated by a study member who is blinded to study groups
      using visual analog scale (VAS). Acetaminophen 1000 mg p.o. were given at 8 hours intervals
      and an intravenous patient-controlled analgesia containing 3 mg/ml of tramadol will be used
      for postoperative pain therapy. Pethidine 0.5 mg/kg IV will be used for rescue analgesic if
      VAS score is greater than 3.

      The motor block will be evaluated using Bromage scale, sensorial block with pin-prick test.
      The duration of motor and sensorial block, postoperative VAS scores, the time to the first
      analgesic requirement, total analgesic consumption and vital parameters will be recorded.
      Patient's satisfaction will be evaluated using 3 point scale between the scores 0 and 2. 0=
      poor 1= fair 2=satisfied Postoperative discharge times will be recorded.
    

Intervention name(s): general anesthesia; ankle block
Intervention type(s): Procedure; Procedure
Intervention description(s): The patient will be monitored with ECG, pulse oximetry and noninvasive blood pressure. Anesthesia will be induced using 2-2.5 mg/kg propofol, 1-2 mcg/kg fentanyl, 10-20 mg rocuronium and proper size Laryngeal mask airway will be placed securely the airway.; ankle nerve block will be performed in group ankle block patients using a mixture of 5 ml of 2% lidocaine and 10 ml of 0.5% bupivacaine and same amount placebo (saline) in groups placebo under the guidance of peripheral nerve stimulator the anesthesia will be discontinued and LMA will be removed. The patients will be transferred from postoperative care unit to the ward after they are eligible for discharge according to modified Aldrete scoring system.
Other intervention name(s): Laryngeal mask airway
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Diagnostic
Keywords: Ankle nerve block; post operative analgesia; patient satisfaction; foot surgery