Fast Track Total Knee Arthroplasty: Local Infiltration Analgesia vs Femoral Nerve Block
Condition: Arthroplasty, Replacement, Knee
Intervention: LIA of the posterior capsule of the knee; LIA of the anterior capsule of the knee; LIA of the subcutaneous tissue of the knee; FNB with catheter
Intervention description: the surgeon infiltrates the posterior capsule of the knee using 100 mL ropivacaine 0.2% with 0.5 mg epinephrine.; the surgeon infiltrates the anterior capsule of the knee using 50 mL ropivacaine 0.2% with 0.25 mg epinephrine.; the surgeon infiltrates the subcutaneous tissue of the knee using 50 mL ropivacaine 0.2% before wound closure.; pre-operatively the anesthesiologist will ultrasound guided place a catheter close to the femoral nerve using sodium chloride (NaCl 0.9%) (no local anesthetic). During surgery, when the LIA of the posterior capsule is performed, 20 mL ropivacaine 0.2% will be administered through the catheter to create a femoral nerve block (FNB). Postoperatively patients will receive 20 mL ropivacaine 0.2% through the catheter 6 times daily for 24 hours
Intervention MeSH terms: Epinephrine; Racepinephrine; Ropivacaine; Epinephryl borate
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 80.0
Sex: All
Minimum age: 50 Years
Maximum age: 80 Years
Healthy volunteers: No
Keywords: total knee arthroplasty; femoral nerve block; local infiltration analgesia; fast track

Summary:

      The objective of this study is to determine whether either a femoral nerve block (FNB) or
      local infiltration analgesia (LIA) is a better anesthetic technique to achieve optimal
      functional outcome after one year in patients receiving a total knee arthroplasty and
      following a fast track rehabilitation protocol.
    

Eligibility criteria:

        Inclusion Criteria:

          -  American Society of Anesthesiologists (ASA) physical health status I-II

          -  patient presents with non-inflammatory primary knee osteoarthritis (radiological
             confirmation)

          -  patient is planned for a primary unilateral posterior-stabilized tri-compartmental
             cemented total knee replacement (Genesis II - PS)

          -  patient is scheduled for fast track protocol

          -  patient plans to be available fot follow-up through one year post-operative

          -  written informed consent

        Exclusion Criteria:

          -  any contra-indication for locoregional anesthesia

          -  any contra-indication for spinal anesthesia

          -  traumatic osteoarthritis requiring TKA

          -  an active, local infection or systemic infection

          -  known hypersensitivity to amide-type local anesthetics

          -  known intolerance or contraindication for opioids, nonsteroidal antiinflammatory drugs
             (NSAIDs) or paracetamol

          -  a Body Mass Index > 40 kg/m2

          -  inability to walk independently (inability to walk at least 10 consecutive meters
             without a walking aid)

          -  scheduled for contralateral TKA within one year postoperative

          -  scheduled for another operation within 3 months postoperative

          -  physical, emotional or neurological conditions that would compromize compliance with
             postoperative rehabilitation and follow-up

          -  chronic opioid analgesic therapy

          -  chronic gabapentin or pregabalin analgesic therapy

          -  rheumatoid arthritis