Ultrasound TFP (Transversalis Fascia Plane) for Analgesia After Iliac Crest Bone Graft Harvest

Study Overview
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Brief Summary
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Iliac crest bone graft harvest is associated with acute pain that can lead to chronic postoperative pain. Local anesthetic infiltration and regional anesthesia could be of interest to reduce opioid consumption during and after surgery, reduce hyperalgesia and the associated risk of chronic postoperative pain. In this surgery, local anesthetic infiltration of the iliac crest is associated with a pain reduction compare with placebo. Some studies have shown the benefit of a TAP (transversus abdominal block) for postoperative analgesia after iliac crest bone graft harvest. The TFP block (transversalis fascia plane block) has been recently described. Considering the nerves trajectories, the TFP block is probably anatomically the most appropriate block for analgesia after iliac crest bone graft harvest. The aim of this study is therefore to assess the benefit of an ultrasound TFP block for analgesia after iliac crest bone graft harvest compare with local anesthetic infiltration Design is prospective, randomized, double blind, controlled study

Official Title
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Intérêt du TFP (Transversalis Fascia Plane) Bloc échoguidé Pour l'analgésie du prélèvement Osseux de crête Iliaque

Conditions
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Patients Scheduled for Iliac Crest Bone Graft Harvest During Upper or Lower Limb Surgery

Intervention / Treatment
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* Drug: TFP block ropivacaine
* Drug: ropivacaine infiltration of the iliac crest bone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years Patients scheduled for iliac crest bone graft harvest during upper or lower limb surgery Exclusion Criteria: Allergy to ropivacaine, propofol, paracetamol, remifentanil, morphine, cisatracurium, ketoprofene, nefopam Weight < 50 kg Pregnancy Severe psychiatric disorder Paraplegia or tetraplegia Spinal anesthesia Contra indication to ketoprofene: age ≥ 75 years, renal insufficiency (creatinine clearance < 50 ml/min), active gastric ulcer, past of asthma with NSAID Contra indication to nefopam: severe cardiac insufficiency, glaucoma, prostate hypertrophy, epilepsy Contra indication to paracetamol: severe hepatic insufficiency Severe respiratory insufficiency Abnormal hemostasis or anticoagulant treatment Chronic use of morphine

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: iliac crest bone graft with a TFP block<br>Regional anesthesia (RA) for the upper or lower limb depending on the surgery + general anesthesia (GA) + TFP block | Drug: TFP block ropivacaine<br> <br> |
| Active Comparator: local anesthetic infiltration of the surgical site.<br>RA for the upper or lower limb depending on the surgery + GA + ropivacaine infiltration of the iliac crest bone | Drug: ropivacaine infiltration of the iliac crest bone<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption 24 hours after the surgery |  | 24 hours |