Comparison of the effectiveness of combined sciatic –femoral nerve blocks together with lateral femoral cutaneous nerve block on thigh tourniquet pain with spinal anesthesia in foot and ankle orthopedic surgery patients

The effect of combined block of lateral femoral cutaneous nerve and femoral nerve on thigh tourniquet pain during unilateral foot or ankle orthopedic surgery.

A two-arm parallel, randomized controlled clinical trial with concealed blinded randomization sequence and blinded outcome assessment.

Sixty patients in Akhtar Hospital affiliated to Shahid Beheshti University of Medical Sciences are randomly enrolled into two equal groups after obtaining informed consent. When a satisfactory level of block is achieved, a thigh tourniquet is inflated in the proximal part of the thigh. The tourniquet pain is assessed by a blinded observer immediately after inflation and then every 5 min with a 5-point verbal rating scale (VRS). If the patient complains of pain or VRS was >1, bolus doses of intravenous fentanyl or ketamine are given alternatively.

AَُSA Ⅰ-Ⅱ patients are included. Patients with allergy to local anesthetics, coagulation disorders, opium addiction, infection at the block site, previous femoral or popliteal bypass surgery, BMI ≥ 30, sickle cell anemia, and lack of cooperation are excluded.

In the Spinal group, 3 ml of 0.5% hyperbaric bupivacaine is injected intrathecally. In the Peripheral nerve block group, popliteal, femoral nerve (FN), and lateral femoral cutaneous nerve (LFCN) block is performed under the guidance of ultrasound. 20 ml of 1.5% lidocaine with epinephrine 1:200000 + bicarbonate is administered for popliteal block, 15 ml and 5 ml of the same solution for FN and LFCN, respectively. After 20 minutes, sensory block is assessed by the pinprick testing and the motor block by the modified Bromage scale by a blinded observer.

Intraoperative tourniquet pain; block performance time; surgical anesthetic effect time; total doses of intraoperative analgesics.

Participants are randomly assigned to 1 of 2 groups following simple randomization by using a random numbers table . The allocation sequence was concealed in sequentially numbered, opaque, sealed envelopes. After acceptance of the eligible patient and in the operating room, the numbered envelope is opened by an investigator with no clinical involvement in the trial. Randomization and assignment of patients is done by a person not involved in the study. The person who measures the outcome in two groups is also kept blinded.

Study Protocol: The whole research protocol are to be shared.

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