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The Effect of Subsartorial Saphenous Block on Postoperative Pain Following Major Ankle and Hind Foot Surgery
Studie Overzicht
Toestand
Interventie / Behandeling
Gedetailleerde beschrijving
Major ankle and hind foot surgery causes intense postoperative pain. Implementation of continuous sciatic catheters has been a great success in reducing postoperative pain following these operations, but despite an effective sciatic catheter patients still report moderate to severe pain from the anteromedial side of the ankle. According to cadaver dissection studies the saphenous nerve innervates the anterior and medial parts of the ankle and talonavicular joint, and even though a saphenous block is standard procedure in many departments of anesthesiology worldwide, scientific evidence regarding the effect of the saphenous block on postoperative pain is lacking.
This study investigates the effect of a selective, ultrasound-guided subsartorial saphenous block on postoperative pain following major ankle and hind foot surgery.
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 4
Contacten en locaties
Studie Locaties
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Aarhus, Denemarken, 8000
- Department of Anesthesiology, Aarhus University Hospital
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Elective ankle or hind foot surgery either: (1) total ankle arthroplasty, (2) ankle arthrodesis (3) subtalar arthrodesis or (4) triple arthrodesis
- Age ≥ 18
- American Society of Anaesthesiology Classification I-III
- Informed consent both orally and in writing after the patient has fully understood the protocol and its limitations.
Exclusion Criteria:
- Communication problems or dementia
- Allergies to any medical product used in the study
- Neuropathy of the sciatic or femoral nerve prior to the operation
- Morbus Charcot-Marie-Tooth disease, diabetic neuropathy, peripheral vascular disease
- Daily use of opioids
- Coagulation disorders
- Infection at the site of injection or systemic infection
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Preventie
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verviervoudigen
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Experimenteel: Bupivacaine-epinephrine
10 mL of 5 mg/mL bupivacaine with 5 μg/mL epinephrine = 50 mg bupivacaine and 50 μg epinephrine
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50 mg bupivacaine and 50 μg adrenalin
Andere namen:
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Placebo-vergelijker: Placebo
10 ml normal saline water (sodium chloride solution, 0,9%)
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9 mg sodium chloride pr.
ml (0,9 %)
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Frequency of patients who experience significant pain at rest (change from no significant pain to significant pain)
Tijdsspanne: Arrival at the Perioperative Section (within 30 minutes after surgery) and at t = 30 min, t = 45 min, t = 60 min, t = 75 min, t = 90 min, t = 105 min, t = 120. The beginning of the observation period (t0) is the registered time for the end of surgery.
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Pain scores evaluated using NRS (numeric rating scale).
Significant pain is defined as NRS > 3 from the anterior and/medial side of the ankle joint.
In case of significant pain, patients receive a rescue saphenous block with 10 ml bupivacaine-adrenaline.
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Arrival at the Perioperative Section (within 30 minutes after surgery) and at t = 30 min, t = 45 min, t = 60 min, t = 75 min, t = 90 min, t = 105 min, t = 120. The beginning of the observation period (t0) is the registered time for the end of surgery.
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Sensory testing, infrapatellar branch (nociception is tested using a standardized Neuropen)
Tijdsspanne: At the time point when the patients report a change to significant pain during the observation period. In case of no significant pain during the observation period, sensory testing is conducted at t = 120 min.
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Test of nociceptive response in the cutaneous innervation area of the infrapatellar branch (branch of the saphenous nerve).
The test is performed in an area from the medial femoral condyle to the midline between the apex of patella and tibial tuberosity.
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At the time point when the patients report a change to significant pain during the observation period. In case of no significant pain during the observation period, sensory testing is conducted at t = 120 min.
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Sensory testing, sciatic nerve (nociception is tested using a standardized Neuropen)
Tijdsspanne: Sensory test is conducted at arrival at the Perioperative Section (within 30 minutes after surgery)
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Test of nociceptive response in the sciatic cutaneous innervation area to confirm full sensory block of the sciatic nerve.
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Sensory test is conducted at arrival at the Perioperative Section (within 30 minutes after surgery)
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Studie directeur: Thomas Fichtner Bendtsen, MD, phD, Department of Anesthesiology, Aarhus University Hospital
Publicaties en nuttige links
Algemene publicaties
- White PF, Issioui T, Skrivanek GD, Early JS, Wakefield C. The use of a continuous popliteal sciatic nerve block after surgery involving the foot and ankle: does it improve the quality of recovery? Anesth Analg. 2003 Nov;97(5):1303-1309. doi: 10.1213/01.ANE.0000082242.84015.D4. Erratum In: Anesth Analg. 2003 Dec;97(6):1557.
- Chen J, Lesser J, Hadzic A, Resta-Flarer F. The importance of the proximal saphenous nerve block for foot and ankle surgery. Reg Anesth Pain Med. 2013 Jul-Aug;38(4):372. doi: 10.1097/AAP.0b013e318295596a. No abstract available.
- Clendenen SR, Whalen JL. Saphenous nerve innervation of the medial ankle. Local Reg Anesth. 2013 Mar 6;6:13-6. doi: 10.2147/LRA.S42603. Print 2013.
- Blumenthal S, Borgeat A, Neudorfer C, Bertolini R, Espinosa N, Aguirre J. Additional femoral catheter in combination with popliteal catheter for analgesia after major ankle surgery. Br J Anaesth. 2011 Mar;106(3):387-93. doi: 10.1093/bja/aeq365. Epub 2010 Dec 17.
- Kalthur SG, Sumalatha S, Nair N, Pandey AK, Sequeria S, Shobha L. Anatomic study of infrapatellar branch of saphenous nerve in male cadavers. Ir J Med Sci. 2015 Mar;184(1):201-6. doi: 10.1007/s11845-014-1087-2. Epub 2014 Feb 18.
- Kerver AL, Leliveld MS, den Hartog D, Verhofstad MH, Kleinrensink GJ. The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery. J Bone Joint Surg Am. 2013 Dec 4;95(23):2119-25. doi: 10.2106/JBJS.L.01297.
- Fisker AK, Iversen BN, Christensen S, Linde F, Nielsen KK, Borglum J, Bendtsen TF. Combined saphenous and sciatic catheters for analgesia after major ankle surgery: a double-blinded randomized controlled trial. Can J Anaesth. 2015 Aug;62(8):875-82. doi: 10.1007/s12630-015-0379-y. Epub 2015 Apr 8.
- Bendtsen TF, Moriggl B, Chan V, Borglum J. Basic Topography of the Saphenous Nerve in the Femoral Triangle and the Adductor Canal. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):391-2. doi: 10.1097/AAP.0000000000000261. No abstract available.
- Bjorn S, Wong WY, Baas J, Nielsen KK, Borglum J, Hauritz RW, Bendtsen TF. The Importance of the Saphenous Nerve Block for Analgesia Following Major Ankle Surgery: A Randomized, Controlled, Double-Blind Study. Reg Anesth Pain Med. 2018 Jul;43(5):474-479. doi: 10.1097/AAP.0000000000000764.
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
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Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Pathologische processen
- Postoperatieve complicaties
- Pijn
- Neurologische manifestaties
- Gewrichtsziekten
- Musculoskeletale aandoeningen
- Reumatische aandoeningen
- Artritis
- Pijn, postoperatief
- Artrose
- Fysiologische effecten van medicijnen
- Adrenerge middelen
- Neurotransmitter agenten
- Moleculaire mechanismen van farmacologische werking
- Depressiva van het centrale zenuwstelsel
- Autonome agenten
- Agenten van het perifere zenuwstelsel
- Sensorische systeemagenten
- Anesthesie
- Adrenerge alfa-agonisten
- Adrenerge agonisten
- Anesthesie, lokaal
- Bronchusverwijdende middelen
- Anti-astmatische middelen
- Agenten van het ademhalingssysteem
- Adrenerge beta-agonisten
- Sympathicomimetica
- Vasoconstrictieve middelen
- Mydriatica
- Bupivacaine
- Adrenaline
Andere studie-ID-nummers
- ProtokolSB2
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
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