Saphenous Nerve Block: Single Shot Versus Continuous Infusion to Supplement a Continuous Sciatic Nerve Block After Major Ankle Surgery
A Randomized Comparison of Single Injection vs. Continuous Saphenous Nerve Block to Supplement a Continuous Sciatic Nerve Block in Postoperative Pain Treatment After Major Ankle Surgery: Clinical Outcome and Cost Analysis
The most useful method to manage pain after major ankle surgery is infusion of local analgesics with a catheter close to the sciatic nerve.
Sensation from the ankle are carried by three nerves: The tibial and peroneal nerve (unified in the sciatic nerve) and the saphenous nerve.
Study purpose is to test whether continuous infusion of local analgesics by saphenous nerve catheter provide a better treatment of pain in comparison with a single injection nerve block. In addition cost-effectiveness of the two methods are compared.
The 50 patients of the trial are randomized in clusters of ten. We intend to do a preliminary analysis of the data from the first 40 patients. However, it is not an interim analysis. Fifty patients will be included independent of the result of the preliminary analysis. The random allocation of the last 10 patients will also be double-blinded.
研究概览
详细说明
Major ankle surgery are known to be very painful the first 48 hours after the operation due to surgical oedema. This pain is difficult to control with systemic analgesics. Pain relief with systemic analgesics requires high doses of intravenous opioids and is associated with breakthrough pain and adverse effects of opioids (sedation, nausea, vomiting, obstipation, urinary retention, respiratory depression).
Continuous, peripheral nerve block with catheter technique for two days minimizes the need for systemic analgesics. Today such a continuous sciatic nerve block is part of the standard pain treatment after major ankle surgery on Aarhus University Hospital. Despite accurate placement of the catheter many patients are in great pain because the saphenous nerve remain unaffected. A single injection block relieve the pain but a block with Ropivacaine only last 8-15 hours.
Severe postoperative pain leads to high opioid dosages, cognitive blurring, nausea, vomiting, reduced ambulation, increased surgical stress response and increased morbidity. Pain problems and adverse effects prolongs postoperative observation time and maybe also time to discharge.
The aim of the study establish whether continuous saphenous nerve block is efficient (pain relief or reduced opioid consumption) and justified (cost-effectiveness analysis) compared with single injection block.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Aarhus、丹麦、8000
- Aarhus University Hospital
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria: Elective major ankle surgery
- total ankle arthroplasty
- subtalar fusion
- ankle fusion (non arthroscopic)
Exclusion Criteria:
- coagulation abnormalities
- infection in the region of needle insertion
- systemic infection
- preoperative consumption of high dose opioid
- preoperative sciatic or femoral nerve neuropathy
- preoperative sensory deficit in either of the lower extremities
- Charcot-Marie-Tooth disorder
- diabetic neuropathy
- severe peripheral vascular disease
- allergy to local anesthetics
- lack of understanding of Numeric Rank Scale (NRS)
- communication problems
- dementia
- body mass index above 35
- bilateral continuous sciatic nerve block
- lack of consent
学习计划
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：三倍
武器和干预
参与者组/臂 |
干预/治疗 |
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有源比较器：0,2% Ropivacaine
Patients randomized to the experimental group receive a continuous infusion of 0,2 % Ropivacaine by elastomeric infusion pump at 5 ml/h in the saphenous catheter after major ankle surgery. Infusion for 48 postoperative hours. All patients receive a preoperative single shot of Ropivacaine around saphenous and sciatic nerve and a postoperative continuous sciatic nerve block. |
0,2% Ropivacaine by elastomeric infusion pump at 5 ml/h for 48 postoperative hours
其他名称：
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安慰剂比较：Control
Patients randomized to the control group receive a continuous infusion of isoton saline by elastomeric infusion pump at 5 ml/h in their catheter after major ankle surgery. Infusion for 48 postoperative hours. All patients receive a preoperative single shot of Ropivacaine around saphenous and sciatic nerve and a postoperative continuous sciatic nerve block. |
Isoton saline by elastomeric infusion pump at 5 ml/h for 48 postoperative hours
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研究衡量的是什么？
主要结果指标
结果测量 |
大体时间 |
|---|---|
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Accumulated opioid consumption
大体时间：First 48 hours postoperative
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First 48 hours postoperative
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Success rate for saphenous nerve analgesia
大体时间：Postoperative, first 48 hours
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Pain rated by NRS and opioid consumption
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Postoperative, first 48 hours
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Success rate for clinical analgesia of foot and ankle
大体时间：Postoperative, first 48 hours
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Pain rated by NRS and opioid consumption
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Postoperative, first 48 hours
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Success rate for tibial and peroneal nerve block
大体时间：Postoperative, first 48 hours
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Pain rated by NRS and test of sensation on the toes
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Postoperative, first 48 hours
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Localisation of worst pain
大体时间：Postoperative, first 48 hours
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Postoperative, first 48 hours
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Cost-effectiveness
大体时间：2 first postoperative days
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2 first postoperative days
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合作者和调查者
调查人员
- 首席研究员：Thomas F Bendtsen, ph.d., MD、Aarhus University Hospital
出版物和有用的链接
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (估计)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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