Effect of Ropivacaine During Popliteal Nerve Block in Foot and Ankle Surgery

Study Overview
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Brief Summary
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With the increasing rise of outpatient surgery in orthopaedic procedures, the management of immediate postoperative pain has been a major topic investigated, with the use of a peripheral nerve block in combination with general anesthesia being a commonly accepted method. Foot and ankle procedures, which offer the choice of several anesthetic techniques, have increasingly been performed with this method predominantly through the combination of general anesthesia with a single-injection popliteal nerve block to reduce the substantial acute postoperative pain that often requires large opioid intake within the post-anesthesia care unit (PACU). However, as a single-injection peripheral nerve block resolves off shortly following surgery, major postoperative pain, termed rebound pain, can also arise, and has the potential to be even greater than that of patients who do not receive any peripheral nerve block with general anesthesia. The purpose of this study is to evaluate the contribution of ropivacaine concentration (0.5% versus 0.25%) of the initial bolus in continuous popliteal nerve blocks toward the rebound pain phenomena, or the quantifiable difference in pain experienced during the initial time after block resolution, in foot and ankle surgeries.

Official Title
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Randomized Study of the Effect of Initial Ropivacaine Dosage During Continuous Popliteal Nerve Blocks on Rebound Pain in Foot and Ankle Surgery

Conditions
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Popliteal Nerve Block, Foot Surgery, Ankle Surgery

Intervention / Treatment
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* Drug: Ropivacaine 0.5% Injectable Solution
* Drug: Ropivacaine 0.25% Injectable Solution
* Drug: Percocet Pill
* Drug: Norco Pill
* Procedure: Foot/Ankle Surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients undergoing foot and ankle surgeries under the care of Dr. Steven Raikin with continuous popliteal blocks at Riverview Surgical Center will be considered for enrollment. Exclusion Criteria: Patients who present with a) known hypersensitivity to ropivacaine or to any local anesthetic agent of the amide type, Existing use of narcotics, Pregnant women, Individuals under the age of 18 Procedures involving any other forms of anesthesia other than general anesthesia with a continuous popliteal nerve block.

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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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard Popliteal Nerve Block<br>Participants undergoing foot or ankle surgery will receive an initial injection of 0.5% ropivacaine as the initial anesthetic followed by continuous injection of 0.25% ropivacaine. | Drug: Ropivacaine 0.5% Injectable Solution<br>* Participants will receive the nerve block preoperatively using 0.5% ropivacaine<br>Drug: Ropivacaine 0.25% Injectable Solution<br>* Participants will receive the nerve block preoperatively using 0.25% ropivacaine<br>Drug: Percocet Pill<br>* After surgery participants will be given a prescription for Percocet to be taken as needed for pain<br>Drug: Norco Pill<br>* After surgery participants will be given a prescription for Norco to be taken as needed for pain<br>Procedure: Foot/Ankle Surgery<br>* Participant will undergo foot or ankle surgery and receive a popliteal nerve block<br>|
| Active Comparator: Partial Popliteal Nerve Block<br>Participants undergoing foot or ankle surgery will receive 0.25% ropivacaine initially followed by the usual continuous injection of 0.25% ropivacaine during surgery | Drug: Ropivacaine 0.25% Injectable Solution<br>* Participants will receive the nerve block preoperatively using 0.25% ropivacaine<br>Drug: Percocet Pill<br>* After surgery participants will be given a prescription for Percocet to be taken as needed for pain<br>Drug: Norco Pill<br>* After surgery participants will be given a prescription for Norco to be taken as needed for pain<br>Procedure: Foot/Ankle Surgery<br>* Participant will undergo foot or ankle surgery and receive a popliteal nerve block<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative Pain | Participants Satisfaction with pain control will be measured using the Visual Analog Scale for Pain (VAS) | 7 days | 
| Postoperative Opioid Usage | For each group, participants will be asked to record their postoperative pain medication usage daily | 7 days |