Comparing Postoperative Functional Recovery and Analgesic Efficacy of a Single Shot Sciatic Nerve Block Versus Posterior Capsule/Fat Pad Infiltration of Local Anesthetic for Total Knee Arthroplasty
Condition: Total Knee Arthroplasty; Post Operative Analgesia
Study type: Interventional

Summary: 
      Many methods of pain relief have been implemented in an attempt to provide safe and effective
      analgesia for patients following total knee arthroplasty. Numerous studies have demonstrated
      that nerve blocks can provide superior pain control and reduce side effects. There are two
      major nerves that provide sensation to the knee: the femoral nerve provides sensation to the
      front of the knee and sciatic nerve provides sensation to the back of the knee. Putting local
      anesthetic close to these nerves provides superior pain control. The literature has supported
      the use of femoral nerve block for analgesia as well as improved functional outcome after
      total knee arthroplasty. The purpose of this study is to see if the same is true for sciatic
      nerve block for the back of the knee. We also would like to study an alternative approach to
      make the back of the knee pain free. This involves injecting local anesthetic directly into
      this area at the end of your surgery.Patients will be randomized into 3 groups: sciatic
      block, posterior infiltration of local anesthetic and placebo.This study will help further
      define the role of sciatic nerve block as well as the alternative technique of local
      anesthetic infiltration in the perioperative analgesic regimen of total knee arthroplasty
      surgery, in an effort to develop a standardized perioperative protocol for this patient
      population. The advent of this protocol should allow reduced risk, improved analgesia, and
      potentially earlier discharged from hospital with better function.
    

Detailed description: 
      The objectives of this study are:

        1. Evaluate the role of sciatic nerve block in total knee replacement. There is conflicting
           data as to whether sciatic nerve block would provide significant analgesic benefit in
           addition to femoral nerve block and the usual multimodal and preemptive analgesic
           regimen for TKA.

        2. Investigate the efficacy of single-shot sciatic nerve block on early rehabilitation,
           functional recovery and patient satisfaction.

        3. Evaluate the previously described technique of local anesthetic infiltration into the
           posterior capsule/fat pad of the knee as an alternative technique to sciatic nerve block
           in providing analgesia to the posterior aspect of the knee in this select group of
           patients.

        4. Investigate the efficacy of local anesthetic infiltration into the posterior capsule/fat
           pad of the knee on early rehabilitation, functional recovery and patient satisfaction.

      Study Design:

      All patients will have a femoral nerve block (FNB) and spinal anesthesia.

      Patients will be randomized into one of the 3 possible groups:

      Group 1: Femoral nerve block + Sciatic nerve block + Spinal anesthesia + Infiltration of
      normal saline at the end of surgery

      Group 2: Femoral nerve block + Sham Sciatic nerve block + Spinal anesthesia + Infiltration of
      local anesthetic at the end of surgery.

      Group 3: Femoral nerve block + Sham Sciatic nerve block + Spinal anesthesia. + Infiltration
      of normal saline at the end of surgery.

      In summary, this study will help further define the role of sciatic nerve block as well as
      the alternative technique of local anesthetic infiltration in the perioperative analgesic
      regimen of total knee arthroplasty surgery, in an effort to develop a standardized
      perioperative protocol for this patient population. The advent of this protocol should allow
      reduced risk, improved analgesia, and potentially earlier discharged from hospital with
      better function.
    

Intervention name(s): Sciatic Nerve Block; Posterior capsule infiltration with local anesthetic; Sham sciatic block and sham posterior infiltration
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Patients randomized to Group 1 will receive a single sciatic nerve block using the infragluteal parabiceps approach, using 20 ml of 0.5 % Ropivacaine. A sham injection of the posterior capsule and fat pad using 50 cc of normal saline will be conducted at the conclusion of the surgery.; Patients randomized to Group 2 will receive a Sham sciatic nerve block using 20cc of normal saline as described above as well as extensive local anesthetic infiltration of the posterior capsule and fat pad with a solution of 50 ml of 0.2% ropivicaine.; Patients randomized to group 3 will only receive a continuous femoral nerve catheter, A sham sciatic nerve block with 20cc of normal saline as well as a sham injection of the posterior capsule and fat pad will be performed with 50cc of normal saline.
Intervention MeSH terms: Anesthetics; Anesthetics, Local
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Knee; Arthroplasty; Sciatic; Nerve; Block; Regional; Anesthesia; Infiltration; Local Anesthetic; Analgesia