genicular nerve block after open reduction internal fixation of tibial plateau

Conditions: Tibial Plateau Fractures

Summary: the investigators are conducting this research study to find better ways of treating pain following knee surgery. there is a standard (accepted) approach, which involves injection of numbing medication into the area around the participant surgical incision. the investigators hope to discover if providing numbing medication to a nerve that controls pain in a larger area of the knee (a nerve block), might be better at post-operative pain control.

the investigators are conducting this research study to find better ways of treating pain following knee surgery like the one the participant will be having. there is a standard (accepted) approach, which involves injection of numbing medication into the area around the participant surgical incision. the investigators hope to discover if providing numbing medication to a nerve that controls pain in a larger area of the knee (a nerve block), might be better at post-operative pain control. this type of nerve block is commonly used to treat other knee pains, like that associated with arthritis, after knee replacements, and after repairs of the knee ligaments; however, it is considered experimental in your case, as its effects (good or bad) are unknown in the type of knee surgery the participant are undergoing. the investigators plan is to decide at random, like the flip of a coin, whether to give numbing medication (0.25% bupivacaine) around the incision like the investigators normally would or give it instead to block the pain sensors around the knee. the participant would get medication either at the incision (shin) or the knee, depending on which arm the participant are in (research). the participant will also be given pain medication pills by your surgeon as part of the participant normal postoperative care (not research).

Eligibility criteria:
inclusion criteria: • any adult patient (ages 18 and over) undergoing open reduction internal fixation of an acute isolated tibial plateau fracture exclusion criteria: * subjects younger than 18 * polytraumatized subjects * subjects with pathologic fractures * subjects with tibial plateau fractures treated nonoperatively * subjects with tibial plateau fractures treated operatively but with re-operations at the same site * subjects with open fractures * subjects with fracture-dislocations * subjects with active or history of anxiety * subjects with visual analog scale anxiety score ≥ 7 measured preoperatively * subjects with chronic pain syndromes * subjects with chronic opioid use * subjects with illicit drug use disorder * subjects with alcohol abuse disorder * subjects with kidney disease precluding use of ketorolac * subjects with liver disease precluding the use of acetaminophen * subjects with allergy to acetaminophen, non-steroidal anti-inflammatory drugs (nsaids), opiates or local anesthesia * subjects with inability to provide a visual analog scale score postoperatively * subjects with contraindications to receiving peripheral nerve blocks, including relevant neurologic deficits, active infection at sites of injections - re-operation at the same site

Keywords: peri-incisional local anesthesia genicular nerve block tibial plateau fractures open reduction internal fixation