Assessment of Knee Pain in Patients Receiving Continuous Femoral Nerve Block Combined With Either Ultrasound Guided Posterior Capsular Injection or Selective Tibial Nerve Block Following Total Knee Arthroplasty
Overview
- Phase
- Not Applicable
- Intervention
- Ropivacaine with Epinephrine
- Conditions
- Posterior Knee Infiltration
- Sponsor
- Trinity Health Of New England
- Enrollment
- 80
- Locations
- 1
- Primary Endpoint
- Pain Intensity
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
To assess pain control after total knee replacement surgery using two different nerve block techniques. The 2 methods are:
- Continuous femoral nerve block with ultrasound guided posterior capsular injection
- Continuous femoral nerve block with ultrasound selective tibial nerve block.
Detailed Description
Patients undergoing total knee replacement surgery experience severe post-operative pain. Continuous femoral nerve block combined with selective tibial nerve block provides optimal pain control in the anterior and posterior aspect of the knee respectively. However, in patients with pre-existing neuropathy of the sciatic nerve, the blockade of tibial nerve is contraindicated because of increased risk of nerve damage that may lead to exacerbation of neurologic symptoms. In such patients where selective tibial nerve block cannot be offered, ultrasound guided posterior knee capsular injection may be an alternative technique for controlling posterior knee pain after surgery. Posterior capsular injection by surgeons intraoperatively, when combined with femoral nerve block has been shown to provide pain control after total knee replacement. With posterior capsular injection, the main trunk of the tibial nerve is spared and only the terminal nerve endings innervating the posterior knee joint is blocked providing effective pain control. In this study, the efficacy of ultrasound guided posterior capsular injections performed pre-operatively will be compared to tibial nerve block in controlling knee pain after surgery. The results of this study may help establish the efficacy of ultrasound guided posterior capsular injection as an alternative to tibial nerve block in patients undergoing total knee arthroplasty.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients having primary, unilateral total knee arthroplasty
- •Age 18-80
Exclusion Criteria
- •History of neurologic disease, neuropathy, diabetes, or major systemic illness
- •Allergy to local anesthetic solution or NSAIDs
- •Pregnancy
- •Chronic use of narcotics
- •Inability to give consent/cooperate with study
Arms & Interventions
Posterior capsular injection
Ultrasound guided posterior capsular injection of ropivacaine with epinephrine
Intervention: Ropivacaine with Epinephrine
Tibial nerve block
Ultrasound selective tibial nerve block of ropivacaine
Intervention: Ropivacaine
Outcomes
Primary Outcomes
Pain Intensity
Time Frame: 48 hours post surgery
Mean Numeric Pain Rating Scale (NPRS) self-reported pain Intensity on a 11-point score (0=no pain to 10= worst possible) in Post Anesthesia Care Unit (PACU) and every 6 hours for 48 hours post surgery
Secondary Outcomes
- Opioid Consumption(24 hours post surgery)
- Plantar Flexion in the Tibial Nerve Distribution(Upon emergence from anesthesia in the PACU)
- Cold Sensation in the Tibial Nerve Distribution(Upon emergence from anesthesia in the PACU)
- Dorsiflexion in the Peroneal Nerve Distribution(Upon emergence from anesthesia in the PACU)
- Sensation in the Peroneal Nerve Distribution(Upon emergence from anesthesia in the PACU)