Comparison of Single-Agent Versus 3-Additive Regional Anesthesia for Foot and Ankle Surgery

Background: This study compared the results of regional blocks containing a single anesthetic, bupivacaine, with those containing bupivacaine and 3 additives (buprenorphine, clonidine, and dexamethasone) in patients undergoing foot and ankle surgery. Methods: Eighty patients undergoing foot and ankl...

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Bibliographic Details
Published in:	Foot & ankle international Vol. 40; no. 10; pp. 1195 - 1202
Main Authors:	Dang, Debbie Y., McGarry, Sean M., Melbihess, Eric J., Haytmanek, Craig T., Stith, Andrew T., Griffin, Matthew J., Ackerman, Katherine J., Hirose, Christopher B.
Format:	Journal Article
Language:	English
Published:	Los Angeles, CA SAGE Publications 01-10-2019
Subjects:	Anesthetics - therapeutic use Ankle - surgery Bupivacaine - therapeutic use Buprenorphine - therapeutic use Clonidine - therapeutic use Dexamethasone - therapeutic use Double-Blind Method Female Foot - surgery Humans Male Nerve Block - methods Orthopedic Procedures - methods Pain Measurement Pain, Postoperative - prevention & control Prospective Studies dexamethasone buprenorphine bupivacaine peripheral nerve block regional anesthesia clonidine multimodal anesthesia
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Summary:	Background: This study compared the results of regional blocks containing a single anesthetic, bupivacaine, with those containing bupivacaine and 3 additives (buprenorphine, clonidine, and dexamethasone) in patients undergoing foot and ankle surgery. Methods: Eighty patients undergoing foot and ankle surgery over a 9-month period were prospectively enrolled and randomized to receive a peripheral nerve block containing either a single anesthetic (SA) or one with 3 additives (TA). Patients, surgeons, and anesthesiologists were blinded to the groups. Patients maintained pain diaries and were evaluated at 1 and 12 weeks postoperatively. Fifty-six patients completed the study. Results: The TA group had a longer duration of analgesic effect than the SA group (average 82 vs 34 hours, P < .05). Forty-eight hours after surgery, 93% of SA blocks, compared with 34% of TA blocks, had completely worn off. The TA group had a longer duration of sensory effects. At 3 months, 10 of 26 (38.5%) TA patients, compared with 3 of 30 (10%) SA patients, reported postoperative neurologic symptoms. Pain scores in both groups were not statistically different at 1 week or 3 months after surgery. Patients in both groups were similarly satisfied with their blocks. Conclusion: Both types of nerve blocks provided equivalent pain control and patient satisfaction in patients undergoing foot and ankle surgery. The 3-additive agent blocks were associated with a longer duration of pain relief and a longer duration of numbness, as well as higher rates of postoperative neurologic symptoms. Longer pain relief may be obtained at the cost of prolonged sensory deficits. Level of Evidence: Level II, prospective comparative study.
ISSN:	1071-1007 1944-7876
DOI:	10.1177/1071100719859020