Effectiveness of Analgesia in Total Knee Arthroplasty

Study Overview
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Brief Summary
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The purpose of this study is to compare the analgesic effectiveness of three techniques: the femoral nerve block, intraarticular infiltration or a combination of both in the control of pain in total knee arthroplasty (KA). The hypothesis to be tested in this study is that the performance multimodal postoperative pain KA combining two analgesic techniques to obtain better analgesia than when applied separately.

Official Title
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Comparison of the Analgesic Effect of Femoral Nerve Block, Intraarticular Infiltration or a Combination of Both in the Control of Pain in Total Knee Arthroplasty

Conditions
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Pain

Intervention / Treatment
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* Drug: several drugs: morphine chloride,ropivacaine,epinephrine,ketorolac
* Drug: ropivacaine,morphine chloride,epinephrine,ketorolac
* Drug: ropivacaine
* Drug: morphine ,ketorolac


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: intervention program for total knee arthroplasty ASA I, II, III over 65 years old Exclusion Criteria: ASA > III patients who refuse the realization of technical loco-regional anesthesia presence of coagulopathy or impaired hemostatic function BMI > 35 Serious intraoperative complications patients undergoing bypass and aortic-femoral or femoro popliteal bypass operated leg patients treated for chronic pain diagnosed processes, different knee osteoarthritis

Ages Eligible for Study
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Minimum Age: 66 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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: femoral block<br> | Drug: ropivacaine<br>* The lock is held before starting the operation, viewing with ultrasound and confirmed the femoral nerve with nerve stimulation at an intensity of 0.5 mA and a frequency of 2 Hz Pajunk 50mm needle, patellar flexion. It be administered 30ml of ropivacaine 0.75% (225mg)<br>|
| Experimental: local infiltration + femoral nerve block<br>Combination of local infiltration with drugs and femoral nerve block | Drug: morphine ,ketorolac<br>* ultrasound-assisted femoral nerve block is performed and leaks intraoperatively with a 100 ml solution containing: 5 mg of morphine to 0.1% (5ml) +30 mg of ketorolac (1 ml) +96 ml of 0.9% saline.<br>|
| Active Comparator: several drugs local infiltration<br> | Drug: several drugs: morphine chloride,ropivacaine,epinephrine,ketorolac<br>* This technique is performed intraoperatively with a 100 ml solution containing: 225 mg of ropivacaine 1% (22.5 ml) + 5 mg of morphine chloride 0.1% (5ml) + 30 mg of epinephrine 1:1000 (0.3 ml ) + ketorolac 30mg (1ml) +71 ml of 0.9% saline<br>Drug: ropivacaine,morphine chloride,epinephrine,ketorolac<br>* This technique is performed intraoperatively with a 100 ml solution containing: 225 mg of ropivacaine 1% (22.5 ml) + 5 mg of morphine chloride 0.1% (5ml) + 30 mg of epinephrine 1:1000 (0.3 ml ) + ketorolac 30mg (1ml) +71 ml of 0.9% saline<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain | Is measured at the time of starting rehabilitation, postoperatively 48 hours using visual analog scale, numerical and categorical verbal pain scale at 12,24 and 48 hours | 48 hours postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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total knee arthroplasty, intraarticular infiltration, femoral block