Regional Anesthesia Block in Fibula Free Flap Reconstruction

Study Overview
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Brief Summary
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Despite many recent advances in pain management, post-operative pain is widely considered to be poorly managed. Furthermore, the mainstay of current pain management is opioids, for which there is strong evidence of ill effects and long-term potential for addiction. There are many studies demonstrating that perineural regional anesthesia can be superior to intravenous opioid analgesia, and that the technique is safe. By using temporary implanted catheters, this method can now deliver prolonged analgesia, thus reducing the need for opioids in the postoperative period. Regional anesthesia is a proven technique and used daily by anesthesiologists, and it is also the first choice for hip and knee replacement surgery for orthopedic surgeons. Patients undergoing head and neck reconstruction with the use of free tissue transfer experience a significant amount of post-operative pain due to the complexity of the surgery, the presence of a head and neck surgical site as well as a secondary donor site, and existing co-morbidities, most commonly malignancy, that also cause significant pain. These patients often require opioids for pain control throughout the hospital stay, and are almost always discharged home with additional opioids. By utilizing regional anesthesia blocks at the donor sites, the investigators can potentially reduce post-operative pain while also reducing the use of opioids.

Official Title
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Does Regional Anesthesia Reduce Postoperative Opioid Consumption in Subjects Undergoing Fibula Free Flap Reconstruction of the Head and Neck: A Prospective Trial

Conditions
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Anesthesia, Local, Surgery, Opioid Use, Pain, Postoperative, Head and Neck Neoplasms

Intervention / Treatment
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* Drug: Ropivacaine injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects undergoing microvascular fibula free flap reconstruction of the head and neck Subjects undergoing primary or secondary reconstruction Exclusion Criteria: Subjects needing elevation of care to the intensive care unit due to remaining intubated for extended period of time or other complications during the peri or post operative period Subjects with surgical complications requiring significant alteration of the treatment plan o Subjects requiring a return to the operating room during admission will be excluded, unless it is for a procedure not related to the original surgery occurring after post op day 3, such as a gastrostomy tube or long term IV access. Subjects with true allergies to the study drugs Subjects undergoing reconstruction with more than 1 free flap, or with the use of any additional regional flaps History of substance dependence or enrollment in a pain management program Any subject currently enrolled in pain management, or currently taking long acting opioids such as methadone or oxycontin. Subjects who do not stay in the hospital for at least 4 days post operatively Subjects requiring anticoagulation will not require modifications prior to receiving regional anesthesia. Inability to properly place catheter or administer the regional anesthesia

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 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: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Regional Nerve Block<br>Subjects in the regional anesthesia cohort will have a regional anesthesia block and/or catheter placement administered according to current hospital policies and our established standard of care. | Drug: Ropivacaine injection<br>* Regional Anesthesia Nerve Block: Incremental injections up to total of 20 mL of 0.5% ropivacaine is administered.<br>|
| No Intervention: No Regional Nerve Block<br>Subjects in the no regional anesthesia cohort will not get pre-operative regional anesthesia, and their surgery and anesthesia will be performed according to normal policies and standard of care in our hospital. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid consumption | Defined by the research team as the subjects' morphine equivalent dose at 72 hours (3 days) post-operatively. The postoperative period commences at extubation. | 72 hours (3 days) post-operatively |