Regional anesthesia is commonly used in orthopedic and surgical procedures in ankle and foot
      surgery to manage pain. The ultrasound-guided nerve block is a safe and effective regional
      anesthesia technique that provides effective pain management, decreasing opioid consumption.

      Postoperative pain management may be challenging and requires a multimodal approach. Regional
      anesthesia techniques in the pediatric ankle and foot surgery population are frequently used
      in postoperative pain management due to ultrasonography's increased experience and
      accessibility.

      Erector spinae plane block (ESP) is a relatively new regional anesthesia technique that
      provides analgesia covering spinal nerves' dorsal and ventral rami. There are few cases
      reports in the literature on the use of ESP block for lower limb surgery, for which it has a
      promising potential for future indication.

      The erector spinae plane block is a safe and effective regional anesthesia technique, which
      has earned new indications perioperatively since its description.

Erector Spinae Plane Block and Ankle and Foot Surgery

Pain

Ankle Injuries

This single-center study was a prospective randomized controlled trial, using parallel groups
      with a 1:1 allocation ratio. Eligible patients were identified by the surgeon and invited to
      participate in the study. If the patient wished to participate in the study, informed consent
      was obtained. The patient was informed of the study's nature, especially that the patient
      would be randomized to receive an ESPB or a sham block before the procedure. A computerized
      randomization program (permuted block randomization) was used to create the allocation before
      the beginning of the study. Research staff not involved in the recruitment process or the
      study's conduct randomized patients at the time of admission to the clinic. Randomization
      allocation was 1:1 between treatment and control groups. Apart from the anesthesiologists who
      performed the blocks, all patients, surgeons, and postoperative nurses remained blinded to
      randomization throughout the study period. The outcome parameters were recorded through a
      study nurse who was not involved in the patients' care.

      All patients received standardized anesthesia, and all blocks were performed by 2
      anesthesiologists who were trained in this technique. A large-bore intravenous (IV) line was
      placed, and patients received midazolam 1 to 2 mg IV for anxiolysis.

      Anesthesia was induced with fentanyl 2 mcg.kg-1 and propofol 2 mg.kg-1 followed by atracurium
      0.5 mg.kg-1 . After intubation, anesthesia was maintained with isoflurane (1 MAC) and
      atracurium 0.1mg.kg-1 as a maintenance dose every 30 min until the end of the procedure.
      After emerging from anesthesia, patients were transferred to the postanesthesia care unit
      (PACU) for a 2-h observation period. Patients were discharged from the PACU when they
      achieved a modified Aldrete score ≥ 9.10. Postoperative analgesia was provided in both groups
      immediately after surgery by PCA fentanyl pump, then oral acetaminophen 1 g four times a day.
      The criteria to stop the fentanyl titration protocol included satisfactory pain control,
      increased sedation (Ramsay sedation scale >2), decreased respiratory rate.

      Statistical Analyses The sample size was estimated to achieve a power of 0.8 to detect a
      supposed medium effect size of 0.7 in between the two groups regarding total morphine
      consumption, with a 2-sided significance level of .05 and allocation ratio of 1. Thirty
      patients in each group were required. Allowing for a 10% loss, 34 patients were recruited in
      each group, for a total of 68 patients. The sample size was determined using G*Power software
      (version 3.1.9.7).

      Descriptive statistics, including age, sex, body mass index, baseline pain scores, procedure
      type, traction time, and procedure time, were comparatively analyzed between the groups.
      Categorical data were compared with chi-squared and Fisher's exact tests as appropriate.
      Continuous data were compared with a 2-sided t test (for normally distributed data) and
      Wilcoxon rank-sum test (for non normally distributed data). For all analyses (primary and
      secondary measures), a P value of .05 was used to determine statistical significance.
      Statistical analyses were conducted using SPSS version 28 (Addinsoft, Paris, France).

Ultrasound

Bupivacaine Hydrochloride

saline solution

Needle

The Analgesic Efficacy of Erector Spinae Plane Block in Ankle and Foot Surgery: A Randomized Controlled Study

0 - 10 with 0: no pain and 10: worst pain

Associate professor of anesthesia

from end of operation to request of analgesia due to pain

1:3 with 1: very satisfied to 3: very unsatified

The control group underwent US-guided sham block at L4 vertebrae level with 20 ml of saline 0.9%. At the level of L4 and after skin sterilization, sham block was administered in a sitting position. Hydro dissection of the interfascial plane between the erector spinae muscle and TP was confirmed by visualizing the local anesthetic spreading in a linear pattern between the muscle and the bony acoustic shadows of the TP. Then, up to 20 ml Saline 0.9% was injected.

The ESP group underwent US-guided ESP block at L4 vertebrae level with 20 ml of bupivacaine 0.25%. After skin sterilization, ESP block was administered in a sitting position. A linear US transducer was placed vertically 3 cm lateral to the midline to visualize back muscles: the trapezius above, the rhomboid major in the middle, and the erector-spinae muscle on the bottom, as well as the TPs with shimmering pleura in between. Next, 2-3 ml of 2% lidocaine was infiltrated. Hydro dissection of the interfascial plane between the erector spinae muscle and TP was confirmed by visualizing the local anesthetic spreading in a linear pattern between the muscle and the bony acoustic shadows of the TP.

Erector Spinae Plane Block and Ankle and Foot Surgery

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Trial Timing

What is this trial about?

What are the participation requirements?

Locations

Location

Status