Efficacy of Gastrocnemius Plane Block for Foot and Ankle Surgery

Condition(s) studied

Investigational drug(s) / intervention(s)

GPB Group : This group will receive ultrasound-guided Gastrocnemius plane block with 30 mL bupivacaine (0.25%): o In lateral position, a high frequency US (Siemens ACUSON X300 Ultrasound System) linear probe (8-12 mhz) will be placed in the popliteal fossa facing the operator. Scanning continue towards the foot, and the gastrocnemius will appear. As the scanning progresses towards the caput fibulae, the soleus gradually becomes visible. Once Gastrosoleus Interfascial Plane is identified, a needle advanced by consultant anesthesiologists who had experience in regional anesthesia in a lateral-to-medial direction into the lower surface of the gastrocnemius (between the gastrocnemius and the soleus). Subsequently, 20 mL bupivacaine (0.25%) will be injected to separate the fascias of the two muscles, allowing the local anaesthetic to diffuse around the tibial nerve through the fascial gap. The needle is then withdrawn to the upper surface of the gastrocnemius, and 10 mL bupivacaine (0.25%) will be injected into the upper surface (between gastrocnemius and deep subcutaneous fascia) to block

SAB: * Patients will receive SAB using 25g spinal needle in the lateral position with rapid crystalloid co-loading. Fifteen milligrams of hyperbaric bupivacaine will be administered at L3-L4 or at L4-L5 interspace in addition to 25 mcg fentanyl. The dose will be reduced to 10 mg in patients aged above 60 years. * SAB will be considered successful when a bilateral block is confirmed at T12. The block success will be assessed by loss of cold (cold ice) and pain (a 23-gauge needle) sensations. If spinal anaesthesia fails, the patient will receive general anaesthesia and will be excluded from the study.

Study summary

The study aim is to evaluate the efficacy of the gastrocnemius plane block (GPB) in providing postoperative analgesia for patients undergoing foot and ankle surgery.

Objectives:

* To evaluate the duration of postoperative analgesia provided by the gastrocnemius plane block
* To assess postoperative opioid or rescue analgesic consumption within the first 24 hours after surgery
* To measure postoperative pain intensity at predefined time intervals using a validated pain scale (e.g., VAS).
* To assess the incidence of block-related complications, including motor weakness, vascular puncture, nerve injury, or local anesthetic systemic toxicity We hypothesize that GPB will result in lower postoperative pain scores and reduce opioid/rescue analgesic consumption compared with standard analgesic management after foot and ankle surgery.

Eligibility

Primary outcome measure(s)

• Time to first postoperative analgesic request — 24 hours
  Time to first postoperative analgesic request

Trial sites (1)

More Cairo University trials in Egypt

Other trials for the same condition