Comparison of Analgesic Duration of Popliteal Block Versus Ankle Block in Patients Undergoing Forefoot Surgery

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Comparison of Analgesic Duration of Popliteal Block Versus Ankle Block in Patients Undergoing Forefoot Surgery

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Procedure: Ankle Block
* Procedure: Sciatic nerve block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who are going to undergo a unilateral forefoot surgery ; ASA I-III ; Aged 18 years or more; Weighing at least 45 kg Exclusion Criteria: Patient refusal and/or language/cognitive barrier Pregnancy Contra-indication for regional anesthesia Opiate or alcohol dependency Concomitant oncological disease with chemotherapy Patients suffering from neuropathic pain

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Ankle Block<br>Ankle block will be performed under ultrasound guidance. | Procedure: Ankle Block<br>* Ankle block will be performed prior to surgery under ultrasound guidance<br>|
| Active Comparator: Popliteal sciatic nerve block (PSNB)<br>PSNB will be performed under ultrasound guidance, along with a saphenous nerve block at the ankle | Procedure: Sciatic nerve block<br>* Sciatic nerve block will be performed prior to surgery under ultrasound guidance<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of analgesia | Time elapsed between block procedure and first iv request of morphine from PCA | 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total opioid consumption at 24h postoperatively | Total consumption of morphine from PCA at 24 postoperative hours | 24 hours after surgery | 
| Pain score at rest at 4 postoperative hours | Pain score (visual analog scale, 0 = minimum; 10 = maximum) | 4 hours after surgery | 
| Pain score on movement at 4 postoperative hours | Pain score (visual analog scale, 0 = minimum; 10 = maximum) | 4 hours after surgery | 
| Pain score at rest at 12 postoperative hours | Pain score (visual analog scale, 0 = minimum; 10 = maximum) | 12 hours after surgery | 
| Pain score on movement at 12 postoperative hours | Pain score (visual analog scale, 0 = minimum; 10 = maximum) | 12 hours after surgery | 
| Pain score at rest at 24 postoperative hours | Pain score (visual analog scale, 0 = minimum; 10 = maximum) | 24 hours after surgery | 
| Pain score on movement at 24 postoperative hours | Pain score (visual analog scale, 0 = minimum; 10 = maximum) | 24 hours after surgery | 
| Block success rate | Success of block assessed by pinprick test | 45 minutes after block procedure | 
| Global patient satisfaction 48h after surgery | Patient satisfaction score (visual analog scale, 0 = minimum; 10 = maximum) | 48 hours after surgery | 
| Complications after block | Report of any intravascular injection or any sensory/motor anomalies | 48 hours after surgery | 
| Rate of neuropathic pain | Rate of patients describing neuropathic pain 4-6 weeks postoperatively | 4-6 weeks postoperatively | 
| Rate of paresthesia | Rate of patients complaining of paresthesia | Up to 24 hours after block procedure | 
| Block procedure time | Time from first ultrasound image to needle withdrawal | Up to 10 minutes after ultrasound scanning |