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Posterior Capsular Injection With Femoral Nerve Block for Total Knee Arthroplasty

Not Applicable
Completed
Conditions
Posterior Knee Infiltration
Interventions
Registration Number
NCT02701296
Lead Sponsor
Trinity Health Of New England
Brief Summary

To assess pain control after total knee replacement surgery using two different nerve block techniques. The 2 methods are:

1. Continuous femoral nerve block with ultrasound guided posterior capsular injection

2. 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.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
80
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

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Posterior capsular injectionRopivacaine with EpinephrineUltrasound guided posterior capsular injection of ropivacaine with epinephrine
Tibial nerve blockRopivacaineUltrasound selective tibial nerve block of ropivacaine
Primary Outcome Measures
NameTimeMethod
Pain Intensity48 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 Outcome Measures
NameTimeMethod
Cold Sensation in the Tibial Nerve DistributionUpon emergence from anesthesia in the PACU

Number of participants with a self reported on a 3-point scale; 0=normal (No Sensory Block), 1= absent cold perception but touch sensation in tact (Partial Sensory Block), 2= absence of touch sensation (Complete Sensory Block)

Opioid Consumption24 hours post surgery

Amount of opioid used for the first 24 hours post surgery

Plantar Flexion in the Tibial Nerve DistributionUpon emergence from anesthesia in the PACU

Blinded nurse assessment on a 3-point scale 0= normal (No Motor Block), 1= weak (Partial Motor Block), 2 = absent (Complete Motor Block)

Dorsiflexion in the Peroneal Nerve DistributionUpon emergence from anesthesia in the PACU

Number of participants with a blinded nurse assessment on a 3-point scale 0= normal (No Motor Block), 1= weak (Partial Motor Block), 2 = absent (Complete Motor Block)

Sensation in the Peroneal Nerve DistributionUpon emergence from anesthesia in the PACU

Number of participants with self reported on a 3-point scale; 0=normal (No Sensory Block), 1= absent cold perception but touch sensation in tact (Partial Sensory Block), 2= absence of touch sensation (Complete Sensory Block)

Trial Locations

Locations (1)

Saint Francis Hospital and Medical Center

🇺🇸

Hartford, Connecticut, United States

Saint Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
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