The Analgesic Effect of Combined Nerve Block and Systemic High Dose Glucocorticoid After Total Knee Arthroplasty.
Condition: Peripheral Nerve Block; Pain
Study type: Interventional
Phase: Phase 4

Summary: 
      Purpose:

      The purpose of this study is to evaluate the postoperative analgesic effect of a combined
      Saphenous nerve block and Obturator nerve block with local infiltration analgesia in the
      tissue around the knee after total kneearthroplasty. In the combined nerve blocks we use a
      mixture of Ropivacaine and Adrenaline combined with high dose systemic dexamethasone and
      Ketorolac and the mixture for local infiltration consist of Ropivacaine, Adrenaline and
      Ketoroloc. The investigators hypothesis is that the combined nerve blocks reduces pain and
      reduces the opioid consumption and thus reduce side effects such as nausea, vomiting and
      lethargy compared to the current treatment with local infiltration analgesia.

      Background:

      Nerve blocks as analgesic treatment after orthopedic surgery is a recognized and proven
      procedure. The nerve blocks have the disadvantage that not only do they anesthetize the
      sensory nerve fibers but also the nerve fibers to the muscles of the leg. The Saphenous nerve
      block causes only stunning of sensory nerves to the knee region. The Obturator nerve block
      causes both stunning of the sensory nerves to the knee region and the thighs inward leading
      muscles, and does not affect the patient's mobilization capacity.

      Both blocks are known to be a good addition to the analgesic treatment. Ropivacaine is a
      well-known local anesthetic. Adrenaline have also been used in other studies, in addition to
      the local anesthetic agent, and has been shown to prolong the effect of the nerve block.
      Saphenous and Obturator nerve block with all four drugs Ropivacaine and Adrenaline combined
      with high dose systemic Dexamethasone has not been systematically investigated in knee
      replacement surgery, and it is not known whether this method will provide better pain
      treatment.

      Method

      The patient can receive one of two treatments, determined randomly:

        -  A. Saphenous and Obturator nerve block with active anesthetics (Ropivacaine, Adrenaline)
           combined with systemic ketoroloc and high dose Dexamethasone and local infiltration
           around the knee joint with placebo medicine (normal saline).

        -  B. Both blocks with placebo medicine (normal saline) and local infiltration around the
           knee joint with activ local anesthetic.

      Neither patient, investigator or staff around the patient will have knowledge of which
      treatment the patient has received.

      The blocks will be placed before the operation and local infiltration around the knee joint
      will be given by the surgeon during the operation.
    


Intervention name(s): Ropivacaine
Intervention type(s): Drug
Other intervention name(s): Adrenalin; Ketorolac; Dexamethasone
Intervention MeSH terms: Dexamethasone; Ketorolac; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: Peripheral nerve block; Total knee Arthroplasty; Dexamethasone