Defining the Best Approach to Block the Pain After Knee Surgery

Study Overview
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Brief Summary
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The study aims to compare standard techniques used to control pain after knee surgery. The investigators hypothesize that the fascia iliaca block is faster, safer and as good as or better than the femoral block, with or without a stimulating catheter.

Detailed Description
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60 patients being treated for ACL repair or knee arthroplasties under regional anesthesia will be randomized to three groups: Fascia Iliaca Block (FIB), Femoral Block (FB) with stimulating catheter or FB without stimulating catheter. A catheter will be placed according to each technique, before the surgery. A bolus of local anesthetic will be given pre-surgery and at the end of the operation, in all groups. A continuous infusion will be started for 48 hours. All patients receive a standard analgesia cocktail and rescue medication. Pain and level of activity, as well as side effects, will be evaluated.

Official Title
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Defining the Best Approach to Block the Pain After Knee Surgery

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Procedure: Fascia Iliaca Block
* Procedure: Femoral Block (with stimulating catheter)
* Procedure: Femoral Block (without stimulating catheter)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients coming for ACL or knee prosthesis surgery Between 18-80 years old Consenting for spinal anesthesia Exclusion Criteria: Major neurologic diseases Obesity with body mass index (BMI) > 30 Infection at the punction sites (back and/or groin) Diabetes mellitus for longer than 5 years Coagulopathy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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

| Intervention/Treatment |
| --- |
|Procedure: Fascia Iliaca Block|nan|
|Procedure: Femoral Block (with stimulating catheter)|nan|
|Procedure: Femoral Block (without stimulating catheter)|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain relief; measured by VAS at rest and on activity |  | before surgery, before discharge from PACU and on evenings of days 1, 2, 7, 60, 90 | 
| pain relief; measured by WOMAC |  | before surgery and at days 7, 60, 90 | 
| pain relief; evaluated from standard datasheet |  | over 48-hour period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| knee range of bending |  | measured before surgery, and at days 7, 60, 90 | 
| thigh circumference 20 cm above the knee |  | measured before surgery and at days 7, 60, 90 | 
| neurological exam of femorocutaneous, femoral and obturator nerves |  | evaluated once spinal anesthesia has worn off, post-surgery, before anesthesia | 
| level of activity; measured using questionnaire |  | at 7-10 days and at 2 and 3 months | 
| need for rescue analgesia |  | in recovery room and at home | 
| need for second bolus or crossing over between groups |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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knee surgery, femoral block, fascia iliaca block, ACL repair, post-operative analgesia, ACL damage, knee damage