Comparative Efficacy of Sciatic and Femoral Blocks in Ankle Surgery

Comparison of Anesthetic and Postoperative Analgesic Efficacy of Femoral and Popliteal Sciatic Block Application With Femoral and Anterior Sciatic Block Application in Ankle Surgery

Comparison of Anesthetic and Postoperative Analgesic Efficacy of Femoral and Popliteal Sciatic Block vs Femoral and Anterior Sciatic Block in Ankle Surgery

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Analgesia; Postoperative Pain Management; Ankle Surgery; Nerve Blocks
• Intervention / Treatment: Procedure: femoral and anterior sciatic nerve block; Procedure: femoral and popliteal sciatic nerve block

Detailed Description

The sciatic nerve, which arises from the sacral plexus, is the largest nerve in the body. It originates in the posterior region of the thigh in the lumbosacral area and is formed from the anterior branches of spinal nerves from L4 to S3 within the pelvis. It exits the pelvis through the greater sciatic foramen directly below the piriformis and then progresses towards the posterior compartment of the thigh, where it usually divides into the common peroneal nerve and the tibial nerve at the upper corner of the popliteal fossa. Sciatic nerve blocks provide both analgesia and anesthesia in surgeries below the knee, knee surgeries involving the posterior compartment, and foot and ankle surgeries. They can be used alone or in combination with an ipsilateral lumbar plexus block or femoral nerve block to provide surgical anesthesia or analgesia for the entire lower extremity.

Various approaches have been described to perform sciatic nerve block, including anterior and popliteal approaches. The anterior approach to the sciatic nerve can be performed as easily and successfully under ultrasound guidance as the popliteal approach. The anterior approach is advantageous when combined with a femoral nerve block, as it is performed with the patient in the supine position. Due to ease of application and high success rates, peripheral blocks have begun to be incorporated into anesthesia and postoperative analgesia strategies in ankle surgeries. The use of ultrasonography plays a crucial role in increasing the success rate of the block and reducing potential complications.

• Study Type: Interventional
• Enrollment (Actual): 140
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Gaziosmanpaşa Training and Research Hospital
  • Gaziosmanpasa
    • Istanbul, Gaziosmanpasa, Turkey (Türkiye), 34255
      • Gaziosmanpasa Training and Research Hospital, Istanbul, 34000

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

• Inclusion Criteria:
• 18-65 years of age
• American Society of Anesthesiologists physical statusⅠ-II

Exclusion Criteria:

• Pregnant
• Neuromuscular disease
• Peripheral neuropathy
• Coagulation disorders
• Allergy to local anesthetics
• Infection at the site where the nerve block will be applied

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Femoral-Anterior sciatic block group; First, in the supine position, the USG probe is placed below the inguinal crease. The femoral nerve is located lateral to the femoral artery, above the iliopsoas muscle. Once the needle tip reaches the nerve, simultaneous nerve stimulation is applied. Patellar movement is observed due to quadriceps muscle contraction upon needle placement. After a negative aspiration test, 20 ml of local anesthetic is injected.For the anterior sciatic block, while the patient was in the supine position, a convex ultrasound (USG) probe was placed transversely approximately 10 cm distal to the inguinal ligament. After visualizing the sciatic nerve as a hyperechoic flat structure, the nerve stimulator was set to 1-1.5 mA, 0.1 ms, and 1 Hz. Using an in-plane technique, the block needle was advanced. Upon reaching the sciatic nerve, when contractions in the calf, foot, or big toe continued at a current of 0.3-0.5 mA, 20 ml of 0.5% bupivacaine was administered following a negative aspiration test.	Procedure: femoral and anterior sciatic nerve block; First, in the supine position, the USG probe is placed below the inguinal crease. The femoral nerve is located lateral to the femoral artery, above the iliopsoas muscle. Once the needle tip reaches the nerve, simultaneous nerve stimulation is applied. Patellar movement is observed due to quadriceps muscle contraction upon needle placement. After a negative aspiration test, 20 ml of local anesthetic is injected.For the anterior sciatic block, while the patient was in the supine position, a convex ultrasound (USG) probe was placed transversely approximately 10 cm distal to the inguinal ligament. After visualizing the sciatic nerve as a hyperechoic flat structure, the nerve stimulator was set to 1-1.5 mA, 0.1 ms, and 1 Hz. Using an in-plane technique, the block needle was advanced. Upon reaching the sciatic nerve, when contractions in the calf, foot, or big toe continued at a current of 0.3-0.5 mA, 20 ml of 0.5% bupivacaine was administered following a negative aspiration test.
Active Comparator: Femoral-popliteal sciatic block group; First, in the supine position, the USG probe is placed below the inguinal crease. The femoral nerve is located lateral to the femoral artery, above the iliopsoas muscle. Once the needle tip reaches the nerve, simultaneous nerve stimulation is applied. Patellar movement is observed due to quadriceps muscle contraction upon needle placement. After a negative aspiration test, 20 ml of local anesthetic is injected.The ultrasound probe is placed transversely at the popliteal crease. The first structure seen is the popliteal artery. Just above and lateral to the artery, the tibial nerve appears as a hyperechoic, oval, and round structure. After identifying the tibial and peroneal nerves, the probe is moved proximally, and it is observed that the nerves join about 5-10 cm above the popliteal crease. The needle is advanced using an in-plane technique. After obtaining the first sciatic nerve stimulation, 20 cc of 0.5% bupivacaine is injected following a negative aspiration test.	Procedure: femoral and popliteal sciatic nerve block; The ultrasound probe is placed transversely at the popliteal crease. The first structure seen is the popliteal artery. Just above and lateral to the artery, the tibial nerve appears as a hyperechoic, oval, and round structure. After identifying the tibial and peroneal nerves, the probe is moved proximally, and it is observed that the nerves join about 5-10 cm above the popliteal crease. The needle is advanced using an in-plane technique. After obtaining the first sciatic nerve stimulation, 20 cc of 0.5% bupivacaine is injected following a negative aspiration test.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analogue Scale values	Visual Analogue Scale is a scale of 0-10 cm in length, expressed by non-standard verbal descriptors (no pain-unbearable pain..) indicating the limits of pain intensity on both sides, horizontally or vertically.	at 1st, 4th,8th 12th ,24th and 48th hours after the surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total amount of opioid requirements	The total tramadol use of the patients in 48 hours will be recorded.	within 48 hours after the surgery

Collaborators and Investigators

• Sponsor: Gaziosmanpasa Research and Education Hospital
• Investigators: Principal Investigator: Döndü GENÇ MORALAR, MD, Gaziosmanpasa Research and Training Hospital

Publications and helpful links

General Publications

• Olofsson M, Nguyen A, Rossel JB, Albrecht E. Duration of analgesia after forefoot surgery compared between an ankle and a sciatic nerve block at the popliteal crease: A randomised controlled single-blinded trial. Eur J Anaesthesiol. 2024 Jan 1;41(1):55-60. doi: 10.1097/EJA.0000000000001929. Epub 2023 Nov 16.

Study record dates

Study Major Dates

• Study Start (Actual): November 24, 2023
• Primary Completion (Actual): July 1, 2024
• Study Completion (Actual): July 1, 2024

Study Registration Dates

• First Submitted: December 26, 2024
• First Submitted That Met QC Criteria: December 26, 2024
• First Posted (Actual): January 3, 2025

Study Record Updates

• Last Update Posted (Estimated): August 28, 2025
• Last Update Submitted That Met QC Criteria: August 21, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: sciatic block; postoperative pain; nerve blocks; ankle surgery; femoral block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Postoperative Complications; Pathologic Processes; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Agnosia
• Other Study ID Numbers: GAZİOSMANPASATREHTAa

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No