Evaluation by Ultrasound Imaging of Local Anesthetic Spread to the Popliteal Fossa During an Adductor Canal Block

Recruiting

• Conditions: Knee Injuries

• Registration Number: NCT06245460
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

Adductor canal block is an effective analgesic technique for major knee surgery. However, the saphenous nerve block is not sufficient to explain this block's efficiency. It has been shown that adductor canal block can spread to the tibial and fibular nerves through the adductor hiatus. However this diffusion's frequency has never been measured. The main objective of this study is to assess the frequency of the spread of the adductor canal block to the fibular and tibial nerves assessed by ultrasound observation at the popliteal fossa.

Detailed Description

Adductor canal block is an effective analgesic technique for major knee surgery. The PROSPECT group recommends this block in first intention for locoregional anesthesia in total knee arthroplasty. It has been shown to not be inferior to femoral nerve block in this indication.

The adductor canal block targets the saphenous nerve and, through its spread in the adductor canal, the posterior branch of obturator nerve and the vastus medialis nerve. However these nerves can't fully explain this block's efficiency.

It has been shown that local anesthetic can spread in the adductor canal to the tibial and fibular nerves through the adductor hiatus. However, this spread is inconstant, and no study has evaluated the frequency of this spread yet.

The main objective of this study is to assess the diffusion's frequency of adductor canal block to fibular and tibial nerves through ultrasound observation at the popliteal fossa.

Study Timeline

• Study First Submitted: 2024-01-30
• Study First Submitted QC: 2024-01-30
• Study First Posted: 2024-02-07
• Study Start: 2024-03-05
• Status Verified: 2024-04
• Last Update Submitted: 2024-04-05
• Last Update Posted: 2024-04-09
• Primary Completion: 2026-03
• Study Completion: 2026-03

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• patients scheduled for elective knee surgery under general anesthesia
• in center of Ambroise Paré hospital
• receiving an adductor canal block

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Exclusion Criteria

• patients cognitively impaired
• patients suffering from peripheral neuropathy at the lower limb
• patients receiving an IPACK block or surgical knee infiltration to complete the adductor canal block analgesia
• patients who refused to take part in this study
• pregnant or breastfeeding patients
• patients under guardianship
• imprisoned patients
• patients without any medical insurance

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Frequency of local anesthetic's spread	at baseline	The primary outcome is the frequency of local anesthetic's spread to tibial and fibular nerve during an adductor canal block, assessed by ultrasound imaging at the popliteal fossa level. The ultrasound images will be recorded and then assessed by two independent anesthesiologists.

Secondary Outcome Measures

Name	Time	Method
Frequency of altered sensibility	at one and four hours	Frequency of altered sensibility and motricity in fibular and tibial nerves territories assessed at one and four hours after the adductor canal block has been performed.
Correlation between local anesthetic spread and clinical alteration	at baseline, hour 1 and hour 4th	Correlation between local anesthetic spread to tibial and fibular nerves during adductor canal block assessed by ultrasound imaging and clinical alteration of sensibility and motricity in these nerves' territories.

Trial Locations

Locations (1)

Department of anesthesia, Ambroise Paré Hospital - APHP; 🇫🇷 Boulogne-Billancourt, France