Pain, Postoperative
Conditions
Brief summary
The popliteal plexus block has been described as an alternative analgesic postoperative pain treatment for total knee arthroplasty. It consists of injecting local anaeshetics inside the distal end of the adductor canal close to the adductor hiatus, adjacent to the femoral artery, between the medial vastus muscle and the adductor magnus muscle, in order to anesthetize the popliteal plexus. However, the analgesic efficacy has never been demonstrated in a randomized controlled trial. Therefore the objective of this study is to investigate the analgesic benefit of this block combined with a continuous femoral nerve block, on patients scheduled for total knee athroplasty.
Detailed description
Patients scheduled to undergo total knee arthroplasty under general anesthesia will be randomly allocated to two groups: continuous femoral nerve block alone or continuous femoral nerve block with addition of a popliteal plexus block. The continuous femoral nerve block will be performed by the anesthesiologist with 15 mLs of ropivacaine 0.5%, under ultrasound guidance before the beginning of the general anesthesia. The popliteal plexus block will be done by the anesthesiology, under ultrasound guidance, before the beginning of the surgery, under general anesthesia. Postoperative analgesia will include acetaminophen (4 x 1000 mg), ibuprofen (3 x 400 mg) and a continuous infusion of Ropivacaine 0.2%.
Interventions
DRUGRopivacaine 0.5% Injectable Solution
Continuous femoral nerve block with injection of 15 mls of Ropivacain 0.5% adjacent to the lateral aspect of the femoral nerve below the fascia iliaca and placement of the catheter within the vicinity of the femoral nerve, juste deep to the fascia iliaca
Sponsors
University Hospital, Geneva
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Intervention model description
Randomized controlled triple-blinded trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients scheduled for total knee athroplasty under general anesthesia * ASA 1-3
Exclusion criteria
* Kidney disease with GFR \< 50 ml/mn * Daily opioid consumption \> 1 month * Allergy to local anesthetics * Neurological problems of the lower extremity * other contraindications to peripheral nerve blocks
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Total iv morphine consumption (mg) | 12 postoperative hours |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average and maximum pain scores (Numeric rating scale 0-10) | 12, 24 and 48 postoperative hours | — |
| Sciatic extension of popliteal plexus block | 2 and 24 postoperative hours | Presence of sensitive or/and motor sciatic extension of popliteal plexus block |
| Plantarflexion and dorsiflexion ankle strength (Newtons) | 2 and 24 postoperative hours | — |
| Total iv morphine consumption (mg) | 24 and 48 postoperative hours | — |
| Popliteal plexus block procedure time (minutes) | When performing the popliteal plexus block | Onset of action = beginning of the disinfection; End of action = end of injection of 15 mls of Ropivacain 0.5% |
| Popliteal plexus block duration of action (hours) | up to 48 postoperative hours | Onset of action = Time from end of infection of 15 mls of Ropivacain 0.5%; End of action = onset of lateral and/or posterior knee pain (With Numeric rating scale ≥ 4) |
| Knee pain localization (anterior, internal, posterior, lateral, medial) | 2, 12, 24 and 48 postoperative hours | — |
Countries
Switzerland
Contacts
Primary ContactKevin Stebler, MD
Outcome results
None listed