From the Department of Anaesthesia, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (MO, AN, JBR, EA).
Eur J Anaesthesiol. 2024 Jan 1;41(1):55-60. doi: 10.1097/EJA.0000000000001929. Epub 2023 Nov 16.
Forefoot surgery is associated with severe postoperative pain. Ankle and sciatic nerve blocks provide satisfactory postoperative analgesia after forefoot surgery, but little is known on their respective duration of analgesia.
This randomised controlled, single-blinded trial tested the hypothesis that after forefoot surgery in the setting of multimodal analgesia, an ankle block provides analgesia superior to that of a sciatic nerve block at the popliteal crease.
A randomised controlled study.
A single centre study in a university hospital in Switzerland, from September 2018 to November 2022.
From 91 patients scheduled for forefoot surgery, 60 met the inclusion criteria of which 56 completed the protocol and their data were available for analysis. Exclusion criteria were existing sciatic nerve deficit, pre-existing peripheral neuropathy, chronic pain diagnosis, pregnancy, or identified contraindications to peripheral nerve block.
Patients undergoing forefoot surgery were randomly allocated to either a multi-injection ankle block (partly under ultrasound guidance) or a sciatic nerve block at the popliteal crease (under ultrasound guidance) combined with a saphenous nerve block at the ankle. Patients in each group received a total of 30 ml of ropivacaine 0.5% and a multimodal analgesic regimen inclusive of dexamethasone, paracetamol, ketorolac then ibuprofen.
The primary outcome was duration of analgesia, defined as time to first morphine request.
Mean ± SD duration of analgesia was 15.4 ± 8.0 h in the ankle block group and 20.0 ± 10.3 h in the sciatic nerve block group ( P = 0.32). Of note, 15 of 26 (58%) and 24 of 30 (80%) patients of the ankle and sciatic nerve block groups did not request any morphine ( P = 0.09). Other secondary outcomes were similar between groups.
Compared with the ankle block, the sciatic nerve block at the popliteal crease does not provide a longer duration of analgesia in patients undergoing forefoot surgery in the setting of multimodal analgesia.
Clinicaltrials.com identifier: NCT03683342.
足前部手术会引起严重的术后疼痛。踝关节和坐骨神经阻滞可为足前部手术后提供满意的术后镇痛，但关于它们各自的镇痛持续时间知之甚少。
本随机对照、单盲试验旨在检验假设，即在多模式镇痛条件下进行足前部手术后，与坐骨神经阻滞相比，踝关节阻滞在胭窝处提供的镇痛效果更优。
随机对照研究。
瑞士一所大学医院的单中心研究，时间为 2018 年 9 月至 2022 年 11 月。
在拟行足前部手术的 91 例患者中，60 例符合纳入标准，其中 56 例完成了方案，其数据可用于分析。排除标准为存在坐骨神经缺损、预先存在的周围神经病变、慢性疼痛诊断、妊娠或发现外周神经阻滞的禁忌证。
接受足前部手术的患者被随机分配到多针踝关节阻滞（部分在超声引导下）或胭窝处坐骨神经阻滞（在超声引导下）加踝关节处隐神经阻滞。每组患者均接受总共 30ml 0.5%罗哌卡因和包括地塞米松、对乙酰氨基酚、酮咯酸和布洛芬在内的多模式镇痛方案。
主要结局为镇痛持续时间，定义为首次要求使用吗啡的时间。
在踝关节阻滞组，镇痛持续时间的平均值±标准差为 15.4±8.0h，在坐骨神经阻滞组为 20.0±10.3h（P=0.32）。值得注意的是，在踝关节阻滞组和坐骨神经阻滞组中，15 例（58%）和 24 例（80%）患者未要求使用任何吗啡（P=0.09）。两组的其他次要结局相似。
与踝关节阻滞相比，在多模式镇痛条件下进行足前部手术时，胭窝处的坐骨神经阻滞并不能提供更长的镇痛持续时间。
Clinicaltrials.com 标识符：NCT03683342。
