Posterior Capsular Injection With Femoral Nerve Block for Total Knee Arthroplasty
- 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
- Patients having primary, unilateral total knee arthroplasty
- Age 18-80
- 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
Group Intervention Description Posterior capsular injection Ropivacaine with Epinephrine Ultrasound guided posterior capsular injection of ropivacaine with epinephrine Tibial nerve block Ropivacaine Ultrasound selective tibial nerve block of ropivacaine
- Primary Outcome Measures
Name Time Method Pain Intensity 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 Outcome Measures
Name Time Method Cold Sensation in the Tibial Nerve Distribution Upon 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 Consumption 24 hours post surgery Amount of opioid used for the first 24 hours post surgery
Plantar Flexion in the Tibial Nerve Distribution Upon 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 Distribution Upon 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 Distribution Upon 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