Anterior Cruciate Ligament Injury, Postoperative Pain
Conditions
Keywords
Peripheral nerve block, Ultrasound
Brief summary
The study aims to investigate the effect of the popliteal plexus block (PPB) on postoperative pain in patients undergoing anterior cruciate ligament (ACL) reconstruction.
Detailed description
Postoperative pain following ACL reconstruction can be alleviated with an ultrasound-guided femoral triangle block (FTB). However, it is the investigators' observation that 10-20 % of the patients still complain of intense pain localized in the center of the knee. Cadaver dissection studies have shown that an injection into the distal part of the adductor canal will spread to the popliteal fossa, and one dissection study showed consistent spread to the popliteal plexus. The study team hypothesized that a PPB will reduce the postoperative pain, when it is used as a supplement to the FTB in patients undergoing ACL reconstruction.
Interventions
PROCEDUREPopliteal plexus block
10 mL Marcain-adrenalin 5 mg/mL + 5 microgram/mL. Ultrasound-guided injection into the distal part of the adductor canal
Sponsors
University of Aarhus
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Pilot study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing ACL reconstruction on one of the two trial sites * Age ≥ 18 * American Society of Anesthesiologists (ASA) status I-III * Informed consent
Exclusion criteria
* Patients unable to cooperate * Patients not able to speak Danish or with other communication problems * Pregnancy * Contraindication towards any medical product used in the study * Preoperatively reduced sensation on the medial and lateral part of the lower leg * Patients with diabetes requiring medical treatment * Preoperative intake of opioids (dosed \> once daily) * ACL revision
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The effect of the popliteal plexus block (PPB) | Pain scores (NRS): 15, 30, 45 and 60 minutes after PPB | Evaluated as the percentage of patients with postoperative pain NRS \>3, dropping in pain score to NRS ≤ 3 after the PPB |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of patients with central knee pain | Pain scores: 15, 30, 45 and 60 minutes after arrival at the post anesthesia care unit (PACU) | The percentage of patients with FTB reporting pain (NRS \>3) localized in the center of the knee in the observation period |
| Onset time for PPB | Pain scores (NRS): 15, 30, 45 and 60 minutes after PPB | Time from withdrawal of the needle until patient reports NRS ≤ 3 |
| The effect of the PPB on cutaneous sensation | Baseline, 30 and 60 minutes after PPB | Tested on the lateral part of the lower leg (pinprick test) |
| The effect of the PPB on muscle strength | Baseline, 60 minutes after PPB | Dorsal flexion and plantar flexion in the ankle joint, measured with a handheld dynamometer) |
Countries
Denmark
Outcome results
None listed