Knee Osteoarthritis, Postoperative Pain
Conditions
Brief summary
Patient suffer from moderate posterior knee pain after TKA despite injection of local anesthetic around the femoral or saphenous nerves. Indeed, the posterior part of the knee is innervated by the sciatic nerve. This nerve is not routinely blocked as clinicians fear to produce a motor block of the leg that might impair the postoperative assessment. An analgesic alternative is the infiltration of the knee with local anesthetics performed by the surgeon. Recently a trial(1) demonstrated that a selective tibial nerve block provides an effective analgesia without a motor blockage when compared with a sciatic nerve block. The objective of this randomized controlled double-blinded trial is to assess whether a tibial nerve block is more effective for the postoperative pain than local infiltration analgesia when there are combined with an adductor canal block, without decreasing the functional parameters.
Interventions
DRUGRopivacaine 0.5% Injectable Solution
Tibial nerve block with 10ml of Ropivacaine 0.5%
DRUGRopivacaine 0.2% Injectable Solution
Infiltration with 25ml of Ropivacaine 0.2% in the posterior knee capsule
Sponsors
Centre Hospitalier Universitaire Vaudois
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient scheduled for a total knee arthroplasty under spinal block. * Patient with a weight above 40kg.
Exclusion criteria
* Patient with ASA IV status. * Contraindication to spinal block, or peripheral nerve blocks. * Neurological deficit of the lower limb. * Patient with renal dysfunction. * Patient with chronic pain, opioid consumption or alcohol consumption. * Pregnancy.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Total morphine consumption (mg) | 24 hours postoperatively |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain scores (numeric rating scale, 0-10) at rest and on movement | 2 hours, 24 hours, 48 hours and 72 hours postoperatively | 0= no pain, 10=the worst pain imaginable |
| Rate of postoperative nausea and vomiting | 2 hours, 24 hours, 48 hours and 72 hours postoperatively | Yes/No |
| Rate of prurit | 2 hours, 24 hours, 48 hours and 72 hours postoperatively | Yes/No |
| Total morphine consumption (mg) | 2 hours, 48 hours and 72 hours postoperatively | — |
| Analgesic duration (minutes) | Postoperative day 0 | Time from the block to the first analgesic request |
| Active flexion | 24hours, 48hours and 72hours postoperatively | Flexion of the knee by the patient measured in degrees |
| Quadriceps muscle strength (numeric scale, 1-5) | 24hours, 48hours and 72hours postoperatively | 1=no contraction, 5=normal strength |
| Distance walked (meters) | 24hours, 48hours and 72hours postoperatively | — |
| Complication of tibial nerve block | up to 1 week | Intravascular injection/hematoma/infection/Common peroneal nerve block |
| Length of stay in hospital | up to 14 days | Days |
| Passive flexion | 24hours, 48hours and 72hours postoperatively | Flexion of the knee by physiotherapist measured in degrees |
Countries
Switzerland
Outcome results
None listed