Saphenous Nerve Block After Tibial Plateau ORIF

Study Overview
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Brief Summary
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Fractures of the tibial plateau, while very painful, typically do not receive nerve blocks. This is because of a concern that the numbness from a nerve block would mask the typically painful symptoms of compartment syndrome, a condition that can lead to a permanent loss of function of the injured limb. Our study aims to evaluate the effectiveness of saphenous nerve block for pain management after surgical repair of a tibial plateau fracture. Based on cadaver studies and our clinical experience, we suspect that the saphenous nerve contributes to pain sensations of the tibial plateau and will not mask the pain from a compartment syndrome. In summary, while saphenous nerve block represents a safe option after tibial plateau open reduction internal fixation (ORIF), we aim to evaluate its effectiveness in this patient population.

Official Title
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Saphenous Nerve Block for Post-Op Pain Control After Tibial Plateau ORIF

Conditions
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Tibial Plateau Fracture, Pain, Postoperative

Intervention / Treatment
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* Procedure: Saphenous Nerve Block with Ropivacaine Treatment
* Procedure: Saphenous Nerve Block with Saline Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Tibial plateau fracture presenting for ORIF Age greater than or equal to 18 years Exclusion Criteria: Other concomitant life-threatening injuries History of chronic pain prior to tibial plateau ORIF Age <18 years old Pregnancy Any condition impairing patient's ability to consent to participation in study Existing condition contraindicating a nerve block Non-English Speaking

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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No

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
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ropivacaine Treatment<br>After the patient has been consented for a post-operative nerve block, physicians will provide a loading dose of Ropivacaine through the catheter. After one hour, the patient will receive their Ropivacaine infusions as per standard protocol. | Procedure: Saphenous Nerve Block with Ropivacaine Treatment<br>* Regional Anesthesia nerve blocks have become standard practice for several orthopedic surgeries for post-operative pain management, however concerns for compartment syndrome have prevented nerve blocks to become common practice for tibial plateau open reduction internal fixation pain management. Interestingly, saphenous nerve blocks do not cover the sciatic nerve, allowing for pain management while reducing concerns that it may possibly mask compartment syndrome. Patients will receive ropivacaine through the catheter from the start of the nerve block.<br>|
| Placebo Comparator: Saline Control<br>After the patient has been consented for a post-operative nerve block, physicians will provide a loading dose of Normal Saline through the catheter. After one hour, the patient will receive their Ropivacaine infusions as per standard protocol. | Procedure: Saphenous Nerve Block with Saline Control<br>* Regional Anesthesia nerve blocks have become standard practice for several orthopedic surgeries for post-operative pain management, however concerns for compartment syndrome have prevented nerve blocks to become common practice for tibial plateau open reduction internal fixation pain management. Interestingly, saphenous nerve blocks do not cover the sciatic nerve, allowing for pain management while reducing concerns that it may possibly mask compartment syndrome. Patients will receive a loading dose of Normal Saline through the catheter. After one hour, the patient will receive their Ropivacaine infusions as per standard protocol.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Scores | Pain scores on a scale from 0 to 10 will be collected by the research staff for 1 hour following the post-operative block. Pain scores will also be collected by the nurses throughout the patient's stay. | Through hospital stay, an average of 3 days | 
| Opioid requirements | Opioid medications recorded in opioid morphine equivalents will be recorded by the research staff for the first hour following the post-operative nerve block. Opioid medications will be collected by the nurses throughout the patient's stay. | Through hospital stay, an average of 3 days | 
| Length of Stay | The patient's length of stay in the hospital will be collected by the research staff following the patient's discharge. | Through hospital stay, an average of 3 days |