Clinical trial NCT04048889: Addition of Popliteal Plexus Block to Continuous Femoral Nerve Block for Total Knee Arthroplasty
Official title: Addition of Popliteal Plexus Block to Continuous Femoral Nerve Block for Total Knee Arthroplasty
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Pain, Postoperative
Lead sponsor: University Hospital, Geneva
Sponsor class: OTHER
First posted: 2019-08-07
Enrollment: 66
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Randomized controlled triple-blinded trial
Primary purpose: TREATMENT

Brief summary: The popliteal plexus block has been described as an alternative analgesic postoperative pain treatment for total knee arthroplasty. It consists of injecting local anaeshetics inside the distal end of the adductor canal close to the adductor hiatus, adjacent to the femoral artery, between the medial vastus muscle and the adductor magnus muscle, in order to anesthetize the popliteal plexus. However, the analgesic efficacy has never been demonstrated in a randomized controlled trial. Therefore the objective of this study is to investigate the analgesic benefit of this block combined with a continuous femoral nerve block, on patients scheduled for total knee athroplasty.

Detailed description: Patients scheduled to undergo total knee arthroplasty under general anesthesia will be randomly allocated to two groups: continuous femoral nerve block alone or continuous femoral nerve block with addition of a popliteal plexus block.

The continuous femoral nerve block will be performed by the anesthesiologist with 15 mLs of ropivacaine 0.5%, under ultrasound guidance before the beginning of the general anesthesia. The popliteal plexus block will be done by the anesthesiology, under ultrasound guidance, before the beginning of the surgery, under general anesthesia.

Postoperative analgesia will include acetaminophen (4 x 1000 mg), ibuprofen (3 x 400 mg) and a continuous infusion of Ropivacaine 0.2%.

Eligibility criteria: Inclusion Criteria:

* Patients scheduled for total knee athroplasty under general anesthesia
* ASA 1-3

Exclusion Criteria:

* Kidney disease with GFR \< 50 ml/mn
* Daily opioid consumption \> 1 month
* Allergy to local anesthetics
* Neurological problems of the lower extremity
* other contraindications to peripheral nerve blocks

Primary outcomes:
measure: Total iv morphine consumption (mg)
timeFrame: 12 postoperative hours
Secondary outcomes:
measure: Total iv morphine consumption (mg)
timeFrame: 24 and 48 postoperative hours
measure: Average and maximum pain scores (Numeric rating scale 0-10)
timeFrame: 12, 24 and 48 postoperative hours
measure: Sciatic extension of popliteal plexus block
timeFrame: 2 and 24 postoperative hours
measure: Plantarflexion and dorsiflexion ankle strength (Newtons)
timeFrame: 2 and 24 postoperative hours
measure: Knee pain localization (anterior, internal, posterior, lateral, medial)
timeFrame: 2, 12, 24 and 48 postoperative hours
measure: Popliteal plexus block procedure time (minutes)
timeFrame: When performing the popliteal plexus block
measure: Popliteal plexus block duration of action (hours)
timeFrame: up to 48 postoperative hours
Other outcomes:
Locations:
city: Geneva
country: Switzerland
facility: Departement of Anesthesia, Hôpitaux Universitaires de Genève
Study officials:
References: