Clinical trial NCT06522620: Effect of Posterior Femoral Cutaneous Nerve Block on Postoperative Posterior Lateral Knee Analgesia in Patients With TKA
Official title: Posterior Femoral Cutaneous Nerve Combined With Proximal Sciatic and Saphenous Nerve Block for Postoperative Posterior Lateral Knee Analgesia in Patients With TKA: a Single-center, Prospective, Randomized Controlled Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Postoperative Pain
Keywords: Posterior Femoral Cutaneous Nerve
Nerve Block
TKA
posterior lateral knee pain
Lead sponsor: General Hospital of Ningxia Medical University
Sponsor class: OTHER
First posted: 2024-07-26
Enrollment: 90
Sex: ALL
Minimum age (years): 45
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The aim of this study was to observe the effects of posterior femoral cutaneous nerve block combined with sciatic and saphenous nerve block compared with sciatic and saphenous nerve block alone on postoperative posterior side of the knee (popliteal fossa) pain and sleep quality in patients with TKA, and to further alleviate postoperative posterior side of the knee pain in patients with TKA and improve the quality of postoperative sleep.

Detailed description: Total knee arthroplasty (TKA) is one of the most common surgical procedures worldwide. Although surgical and anesthesia techniques have become more mature, poor postoperative pain control after TKA is still an important problem for patients and clinicians. Peripheral nerve blocks (PNBs) have been widely used in clinical practice for postoperative analgesia after TKA.The combinations of PNBs available for postoperative analgesia after TKA include femoral/obturator , femoral/sciatic/obturator, lumbar plexus/sciatic, and femoral/sciatic, and the combination of PNBs has been shown to be effective for postoperative analgesia after TKA in a study of TKA. Meta-analysis of postoperative pain management modalities, it was concluded that blocking multiple nerves was superior to blocking any of the nerves, periarticular infiltration, or epidural analgesia, while the combination of femoral and sciatic nerve block was overall the best postoperative analgesia for TKA. The investigators found that even in patients who underwent a single combined sciatic nerve and saphenous nerve block + continuous femoral nerve block, poor quality of sleep and pain in the affected limb were still common in the postoperative period, and the complaints of pain in the affected limb were mainly centered on the posterior side of the knee (popliteal fossa) and the margins. The area where the patient's complaints were concentrated was within the range of superficial skin sensation innervated by the posterior femoral cutaneous nerve, which is a pure sensory nerve that originates from the lumbosacral plexus, descends through the lower border of the pectineus muscle, and sends out three branches, among which the posterior femoral cutaneous branch innervates superficial sensation in the posterior thigh and popliteal fossa, and the innervation of the posterior femoral cutaneous nerve is not only limited to the posterior thigh and popliteal fossa, but may also extend to the ankle joint. even extend to the ankle joint. The investigators hypothesized that a posterior femoral cutaneous nerve block could reduce pain in the posterior side of the knee in patients after TKA, and there is a theoretically feasible anatomical basis for this hypothesis. Pain is one of the most important factors affecting the quality of sleep in patients, and pain relief may potentially improve the quality and prolong the duration of sleep in patients, thus providing the conditions for comfortable medical treatment and a good prognosis.

Eligibility criteria: Inclusion Criteria:

1. Patients who are \>45 years of age; intended to undergo elective first TKA under general anesthesia
2. ASA grade II-III.
3. Agreed to participate in this study and signed the informed consent form.
4. BMI less than 28Kg/m2.

Exclusion Criteria:

1. Patients who refuse to participate in the trial
2. Preoperative inability to communicate due to speech and hearing impairment, etc.
3. History of allergy to local anesthetics or opioids
4. Contraindications to nerve block operation.

Primary outcomes:
measure: Postoperative anteroposterior and posterior knee Visual Analogue Scale scores (passive motion/resting)
timeFrame: postoperative hour 1，postoperative hour 6，postoperative hour 24，postoperative hour 48
Secondary outcomes:
measure: Postoperative night sleep time
timeFrame: First night after surgery, second night after surgery
measure: Earliest time on the ground
timeFrame: Within 48 hours of surgery
measure: Amount of remedial opioid use
timeFrame: Within 48 hours of surgery
measure: Number of patient PCNA uses
timeFrame: Within 48 hours of surgery
measure: Incidence rate of postoperative adverse outcomes
timeFrame: Within 48 hours of surgery
measure: Hip Knee Ankle
timeFrame: within the preoperative week versus the postoperative week
Other outcomes:
Locations:
city: Yinchuan
country: China
facility: General hospital of Ningxia medical university
state: Ningxia
Study officials:
References: