The Efficacy and Safety of Lower Limb Nerve Blocks in Postoperative Analgesia for the Free Flap Donor Sites
The Efficacy and Safety of Lower Limb Nerve Blocks in Postoperative Analgesia for the Free Flap Donor Sites
The use of free fibular flaps and anterolateral thigh (ALT) flaps for repairing the
 oromandibular defects is well established, whereas few attentions were focused on
 postoperative analgesia for the donor area. The purpose of this trial is to determine if
 using lower limb nerve blocks in patients undergoing free flap-based oromandibular
 reconstruction can significantly decrease use of pain medications and to evaluate the safety
 of lower limb nerve blocks.

 Patients with oromandibular defects who were scheduled for elective reconstructive surgery
 using free fibular or ALT flaps, were divided into two groups in a randomized, single-blind
 fashion. In Group PCA, only intravenous patient controlled analgesia (PCA) was used
 postoperatively. In Group PCA+B, both intravenous PCA and lower limb blocks were used.
 Post-operative narcotic usage, post-operative pain score, post-operative anti-emetic usage,
 vital signs, onset and duration of sensory and motor block, the presence of adverse effects
 such as nausea and vomiting were recorded.
The use of free fibular flaps and anterolateral thigh (ALT) flaps for repairing the
 oromandibular defects is well established, whereas few attentions were focused on
 postoperative analgesia for the donor area. Conventional postoperative pain management
 following oromandibular reconstruction consists of systemic opioids, which can cause nausea,
 vomiting, pruritus, urinary retention, constipation and respiratory depression. Adequate
 postoperative analgesia decreases the incidence of cardiopulmonary complications. Peripheral
 nerve blocks can attenuate the sensory innervations.The purpose of this trial is to determine
 if using lower limb nerve blocks in patients undergoing free flap-based oromandibular
 reconstruction can significantly decrease use of pain medications and to evaluate the safety
 of lower limb nerve blocks.

 Patients with oromandibular defects, who were scheduled for elective reconstructive surgery
 using free fibular or ALT flaps, were divided into two groups in a randomized, single-blind
 fashion. In Group PCA, only intravenous patient controlled analgesia (PCA) was used
 postoperatively. In Group PCA+B, both intravenous PCA and lower limb blocks were used. For
 patients with fibular flaps harvested, femoral nerve block and common peroneal nerve with
 ropivacaine were administered. For patients with ALT flaps harvested, femoral nerve block
 with ropivacaine was administered. Post-operative narcotic usage, post-operative pain score,
 post-operative anti-emetic usage, vital signs, onset and duration of sensory and motor block,
 the presence of adverse effects such as nausea and vomiting were recorded.
Inclusion Criteria:

 -  Prior diagnosis or presumed diagnosis of oral and maxillofacial tumor.

 -  Undergoing microsurgical oromandibular reconstruction with free fibular flaps and
 anterolateral thigh flaps.

 -  Greater than 18 years old.

 -  Ability to understand and the willingness to sign a written informed consent document.

 Exclusion Criteria:

 -  True allergy to local anesthetics or opioids.

 -  History of addiction to narcotics within the last 24 months

 -  History of chronic pain on opioids within the last 24 months.

 -  Specific mental health issues such as schizophrenia or bipolar disorder.

 -  Patients who are pregnant.