Interest of a Bi-truncal Nerve Block (Femoral + Sciatic) Extended, Systematically Associated With General Anesthesia, in the Femoropopliteal Bypass: Study of Post-operative Analgesia and Peripheral Circulation Downstream
Condition: Peripheral Arterial Occlusive Disease
MeSH terms: Arterial Occlusive Diseases
Study type: Interventional
Phase: Phase 4

Summary: 
      The aim of this study is to assess, in patients scheduled for femoropopliteal bypass, the
      benefit of a double peripheral nerve block (femoral + sciatic) with levobupivacaine and
      clonidine in a single dose, performed before induction of general anaesthesia, on analgesia
      postoperatively assessed by morphine consumption.

      Applied to the patient at the beginning of general anesthesia, this technique could allow one
      hand, to reduce the need for opiates, on the other hand - due to anesthetized limb
      vasodilation - to improve tissue perfusion downstream.
    

Detailed description: 
      Course of the study Visit 1 (J-15 J-1): Pre-inclusion During a follow-up visit usual
      pathology, the doctor will propose to the patient to participate in the protocol. Information
      Form will be given to the patient to be read at home to maintain a sufficient time for
      reflection.

      Visit 2 (J-1): Pre-anesthetic, the eve of the intervention:

      During the pre-anesthetic consultation routine, the doctor will check the informed consent
      and then note the following information on the case report form: age, height, weight, sex of
      the patient.

      Visit 3 (J0): Surgery One hour before surgery the patient will receive premedication with
      Hydroxyzine (Atarax ®).

      Then the anesthetic team install patient in monitoring room so that the test products are
      administered according to the double-blind randomization schedule prepared in advance. When
      the block is made, the patient is brought into the operating room for general anesthesia and
      surgery.

      By the end of surgery, the following data will be collected in the case report form :

        -  Vital parameters (heart rate, blood pressure, PetCO2, SpO2) every 10 minutes and
           incidents.

        -  Time of injection tested products and time of induction of general anesthesia.

        -  Major Surgical times : incision, venous sampling when indicated, heparin bolus, clamping
           the superficial femoral artery, arterial unclamping, skin closure.

        -  Duration of operation (in minutes from the incision to skin closure).

        -  Intraoperative sufentanil consumption (micrograms).

      Monitoring and medical care in Post Anaesthesia Carry Unit (PACU):

      After surgery, the patient will be conducted in PACU. He will benefit from routine monitoring
      of vital parameters (heart rate, blood pressure, respiratory rate and SpO2).

      Then patient extubation, according to usual criteria, will be performed: extubation of the
      patient is the H0, when all the time measurement start.

      - H0: Extubation Morphine consumption will be measured continuously during the 72 first
      postoperative hours.

      rSO2 be measured by NIRS during the first 12 first postoperative hours.

        -  H0 +30 min: rating of pain (simple numerical scale) + sedation score

        -  H0 +60 min: rating of pain + sedation score

        -  H0 +90 min: rating of pain

        -  H0 +120 min: rating of pain + sedation score

        -  H0+4h: rating of pain + sedation score

        -  H0+8h: rating of pain + sedation score

        -  H0+12h: rating of pain

        -  H0+16h: rating of pain + sedation score

        -  H0+20h: rating of pain

        -  H0+24h: rating of pain + sedation score + morphine consumption with PCA and number of
           requests over the last 24 hours.

        -  H0+32h: rating of pain

        -  H0+40h: rating of pain

        -  H0+48h: rating of pain + morphine consumption with PCA and number of requests over the
           last 24 hours.

        -  H0+56h: rating of pain

        -  H0+64h: rating of pain

        -  H0+72h: rating of pain + morphine consumption with PCA and number of requests over the
           last 24 hours.

        -  At the end of PACU: rating of pain + sedation score

      Thereafter, recovery time of ambulation will be registered and duration of hospital stay,
      rate of reoperation within 30 post-operative days and 30-day survival.

      Adverse events will be collected to have information about hemodynamic tolerance of the
      products.

      The patient is then monitored in the usual care of the disease.
    

Intervention name(s): levobupivacaine, clonidine
Intervention type(s): Drug
Intervention MeSH terms: Clonidine; Levobupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Nerve block; Femoropopliteal bypass; Postoperative analgesia; Peripheral circulation; Levobupivacaine; Clonidine; Pain