Perioperative Analgesia After Knee Arthroplasty

Study Overview
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Brief Summary
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The purpose of this study is to compare two accepted methods of pain control in knee arthroplasty surgery.The first method combines the periarticular injection of ropivacaine with continuous blockade of the femoral nerve.The second method uses periarticular infiltration of ropivacaine in combination with an bolus of ropivacaine into an intraarticular catheter placed intraoperatively followed by a continuous intraarticular infusion of ropivacaine. All patient will also receive a sustained-release oral opioid and oral rescue opioids determined by pain severity using the Visual Analog Scale (VAS)

Official Title
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Perioperative Analgetic Therapy After Knee Arthroplasty

Conditions
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Knee Arthroplasty

Intervention / Treatment
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* Procedure: Continuous femoral nerve block + periarticular infiltration
* Procedure: Intraarticular and periarticular ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elective primary knee arthroplasty ASA I,II,&III patients Spinal Anaesthesia Exclusion Criteria: Patients refusing consent Contraindications to regional anaesthesia Preexisting neurological disease Alcohol or drug abuse Inability to use the outcome assessment tools Wheel chair or walker dependent Pregnancy

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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: CFNB, periarticular infiltration<br> | Procedure: Continuous femoral nerve block + periarticular infiltration<br>* Initial bolus of ropivacaine 5mg/ml 30mls into the femoral-nerve-catheter preoperatively. Periarticular infiltration of ropivacaine 2mg/ml 150 mls intraoperatively. Continuous perineural infusion of ropivacaine 2mg/ml at a rate of 6 mls/hr postoperatively. Rate can be adjusted to achieve optimal pain control and avoid motor blockade.<br>* Other names: CFNB plus periarticular infiltration;|
| Active Comparator: Intraarticular catheter, periarticular infiltration<br> | Procedure: Continuous femoral nerve block + periarticular infiltration<br>* Initial bolus of ropivacaine 5mg/ml 30mls into the femoral-nerve-catheter preoperatively. Periarticular infiltration of ropivacaine 2mg/ml 150 mls intraoperatively. Continuous perineural infusion of ropivacaine 2mg/ml at a rate of 6 mls/hr postoperatively. Rate can be adjusted to achieve optimal pain control and avoid motor blockade.<br>* Other names: CFNB plus periarticular infiltration;Procedure: Intraarticular and periarticular ropivacaine<br>* Periarticular infiltration of 150 mls ropivacaine 2mg/ml intraoperatively, intraarticular injection of 40 mls ropivacaine 2 mg/ml at skin closure followed by infusion of ropivacaine 2 mg/ml at a rate of 4 mls/hr delivered by an intraarticular catheter until the morning of postoperative day 3.<br>* Other names: Intraarticular ropivacaine plus periarticular ropivavaine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Static and dynamic pain scores (VAS) |  | 72 h | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum knee flexion (active/passive)>= 90° |  | 72 h | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Knee arthroplasty, perioperative analgesia