• Martin Charvin, François Longeras, Philippe Jouve, Anne-Laure Cherprenet, Emmanuel Futier, Bruno Pereira, and Christian Dualé.
• From the CHU Clermont-Ferrand, Médecine Péri-Opératoire (MC, FL, PJ, A-LC, EF); Université Clermont-Auvergne (EF); CHU Clermont-Ferrand, Unité de Biostatistiques, Direction de la Recherche Clinique et des Innovations (BP); CHU Clermont-Ferrand, Centre de Pharmacologie Clinique (CD); and INSERM, CIC1405 & UMR1107, Clermont-Ferrand, France (CD).
• Eur J Anaesthesiol. 2020 Sep 1; 37 (9): 787-795.

BackgroundAdding a regional block to general anaesthesia can prevent postoperative pain and improve peripheral circulation.ObjectiveTo seek improved postoperative analgesia and care due to a long-acting combined femoral and sciatic nerve block in patients undergoing femoropopliteal bypass surgery.DesignA randomised, double-blind, controlled trial.SettingVascular surgery unit of a French university hospital.PatientsForty-four adults scheduled for bypass surgery under general anaesthesia.InterventionPatients were allocated to receive either an active nerve block with 20 ml of 0.375% levobupivacaine and clonidine 0.5 μg kg, or a simulated (sham) block only, but with local anaesthesia of the skin, before general anaesthesia. General anaesthesia was standardised with propofol, then sevoflurane and sufentanil adjusted according to clinical need. Postoperative analgesia was standardised with paracetamol 1 g every 6 h, and intravenous morphine, initially titrated in the postanaesthesia care unit and then patient-controlled. Oral analgesics were repeated up to day 3.Main Outcome MeasuresThe primary outcome was morphine consumption during the first 24 postoperative hours. In a subgroup of postoperative patients distal tissue oxygen saturation was recorded at the lateral side of the blocked calf.ResultsPatients in the active group received less intra-operative sufentanil (median dose 25 vs. 41 μg), needed less morphine during the first 24 h (15 vs. 27 mg) and 72 (20 vs. 35 mg) postoperative hours, than in the control group. They also had less pain on movement, but pain at rest, the tissue oxygen saturation and other rehabilitation outcomes were unaffected by the treatment. Tolerance outcomes were also similar between groups.ConclusionCombining the two regional blocks improves the quality of postoperative care in this frail population, probably by reducing the amount of peri-operative opioid.Trial RegistrationClinicalTrials.gov (ref. NCT01785693).

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