Addition of Popliteal Plexus Block to Continuous Femoral Nerve Block for Total Knee Arthroplasty

Study Overview
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Brief Summary
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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
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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%.

Official Title
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Addition of Popliteal Plexus Block to Continuous Femoral Nerve Block for Total Knee Arthroplasty

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Drug: Ropivacaine 0.5% Injectable Solution
* Drug: Ropivacaine 0.5% Injectable Solution
* Drug: Ropivacaine 0.5% Injectable Solution


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized controlled triple-blinded trial
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Popliteal plexus block and continuous femoral nerve block<br> | Drug: Ropivacaine 0.5% Injectable Solution<br>* 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.<br>* Other names: Continous femoral nerve block;Drug: Ropivacaine 0.5% Injectable Solution<br>* Popliteal plexus block with injection of 15 mls of Ropivacain 0.5% 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, done under general anesthesia.<br>* Other names: Popliteal plexus block;|
| Active Comparator: continuous femoral nerve block<br> | Drug: Ropivacaine 0.5% Injectable Solution<br>* 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<br>* Other names: Continous femoral nerve block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total iv morphine consumption (mg) |  | 12 postoperative hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total iv morphine consumption (mg) |  | 24 and 48 postoperative hours | 
| Average and maximum pain scores (Numeric rating scale 0-10) |  | 12, 24 and 48 postoperative hours | 
| Sciatic extension of popliteal plexus block | Presence of sensitive or/and motor sciatic extension of popliteal plexus block | 2 and 24 postoperative hours | 
| Plantarflexion and dorsiflexion ankle strength (Newtons) |  | 2 and 24 postoperative hours | 
| Knee pain localization (anterior, internal, posterior, lateral, medial) |  | 2, 12, 24 and 48 postoperative hours | 
| Popliteal plexus block procedure time (minutes) | Onset of action = beginning of the disinfection; End of action = end of injection of 15 mls of Ropivacain 0.5% | When performing the popliteal plexus block | 
| Popliteal plexus block duration of action (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) | up to 48 postoperative hours |