Optimal Analgesia for Forefoot Surgery

NCT ID: NCT02637362

Last Updated: 2018-05-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

69 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-02-02

Study Completion Date

2019-06-30

Brief Summary

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A randomised trial comparing three analgesic strategies for patients undergoing forefoot surgery in a day-surgery setting.

Detailed Description

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Forefoot surgery, including Scarf-Akin osteotomy surgery for bunion correction, is moderately painful orthopaedic surgery, commonly performed as a day-case procedure. Admission for opiate analgesia constitutes a failure of management and financial disadvantage to the healthcare organisation. The investigators seek to establish which technique will result in the best analgesia out of ankle block, metatarsal block, or a combination of the two. As analgesia constitutes part of a return to function, an additional aim is to determine whether either of these approaches will result in an objective functional benefit to the participants.

The trial seeks to recruit 23 patients into either of 3 groups: Ankle + sham metatarsal; sham Ankle + metatarsal; Ankle + Metatarsal.

Conditions

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Hallux Valgus Conduction Block

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Ankle + Sham metatarsal

Ankle block + sham metatarsal block

Group Type ACTIVE_COMPARATOR

Ankle block

Intervention Type PROCEDURE

Ultrasound guided ankle block of the tibial, superficial peroneal and deep peroneal nerves will be performed using a standardised technique

Sham metatarsal block

Intervention Type PROCEDURE

In the supine position, after the surgical incision has been sutured, a 25G standard bevel needle will be placed against the skin at the points at which the practitioner would normally have performed insertions of the needle. It will remain there for a total of 30 seconds and then be removed.

Ankle + Metatarsal

Ankle block + metatarsal block

Group Type ACTIVE_COMPARATOR

Ankle block

Intervention Type PROCEDURE

Ultrasound guided ankle block of the tibial, superficial peroneal and deep peroneal nerves will be performed using a standardised technique

Metatarsal block

Intervention Type PROCEDURE

A metatarsal block will be performed using a standardised technique

Metatarsal + sham ankle

Metatarsal block + sham ankle block

Group Type ACTIVE_COMPARATOR

Sham ankle block

Intervention Type PROCEDURE

In the supine position with the hip and knee flexed, and the hip externally rotated, the skin from medial malleolus to Achilles tendon will be prepared with chlorhexidine 0.5% solution and allowed to dry. An ultrasound probe (linear array HFL25, Sonosite, Hitchin, UK) will be placed on a line from medial malleolus to achilles tendon to identify the posterior tibial artery and tibial nerve. A Stimuplex A50 needle (B-Braun) will be placed against the skin at the point at which the practitioner would normally have performed insertion of the needle. It will remain there for a total of 30 seconds and then will be removed.

Metatarsal block

Intervention Type PROCEDURE

A metatarsal block will be performed using a standardised technique

Interventions

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Ankle block

Ultrasound guided ankle block of the tibial, superficial peroneal and deep peroneal nerves will be performed using a standardised technique

Intervention Type PROCEDURE

Sham ankle block

In the supine position with the hip and knee flexed, and the hip externally rotated, the skin from medial malleolus to Achilles tendon will be prepared with chlorhexidine 0.5% solution and allowed to dry. An ultrasound probe (linear array HFL25, Sonosite, Hitchin, UK) will be placed on a line from medial malleolus to achilles tendon to identify the posterior tibial artery and tibial nerve. A Stimuplex A50 needle (B-Braun) will be placed against the skin at the point at which the practitioner would normally have performed insertion of the needle. It will remain there for a total of 30 seconds and then will be removed.

Intervention Type PROCEDURE

Metatarsal block

A metatarsal block will be performed using a standardised technique

Intervention Type PROCEDURE

Sham metatarsal block

In the supine position, after the surgical incision has been sutured, a 25G standard bevel needle will be placed against the skin at the points at which the practitioner would normally have performed insertions of the needle. It will remain there for a total of 30 seconds and then be removed.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Participant is willing and able to give informed consent for participation in the study.
* Male or female, aged 18 years or above.
* Diagnosed with 1st metatarsal pathology requiring surgical correction
* Participant meets the criteria for operative management in our day-surgery unit

Exclusion Criteria

* Contraindication to general anaesthesia
* Diabetic neuropathy affecting lower limbs
* Peripheral neuropathy affecting lower limbs of any aetiology
* Revision surgery
* Lack of capacity to consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Queen Elizabeth Hospital NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Dr James Stimpson

Consultant Anaesthetist

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Queen Elizabeth Hospital NHS Trust

Kings Lynn, Norfolk, United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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James A Stimpson, MBChB

Role: CONTACT

+44 (01553) 613613 ext. 3583

Facility Contacts

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James A Stimpson, MBChB

Role: primary

01553613613 ext. 3583

Other Identifiers

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JSCP1

Identifier Type: -

Identifier Source: org_study_id

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