Addition of Popliteal Plexus Block to Continuous Femoral Nerve Block for Total Knee Arthroplasty

Not Applicable

• Conditions: Pain, Postoperative
• Interventions: Drug: Ropivacaine 0.5% Injectable Solution

• Registration Number: NCT04048889
• Lead Sponsor: University Hospital, Geneva

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%.

Study Timeline

• Study Start: 2019-07-22
• Study First Submitted: 2019-07-27
• Status Verified: 2019-08
• Study First Submitted QC: 2019-08-06
• Last Update Submitted: 2019-08-06
• Study First Posted: 2019-08-07
• Last Update Posted: 2019-08-07
• Primary Completion: 2022-03-01
• Study Completion: 2022-07-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 66

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Popliteal plexus block and continuous femoral nerve block	Ropivacaine 0.5% Injectable Solution	-
continuous femoral nerve block	Ropivacaine 0.5% Injectable Solution	-

Primary Outcome Measures

Name	Time	Method
Total iv morphine consumption (mg)	12 postoperative hours

Secondary Outcome Measures

Name	Time	Method
Average and maximum pain scores (Numeric rating scale 0-10)	12, 24 and 48 postoperative hours
Popliteal plexus block duration of action (hours)	up to 48 postoperative hours	Onset of action = Time from end of infection of 15 mls of Ropivacain 0.5%; End of action = onset of lateral and/or posterior knee pain (With Numeric rating scale ≥ 4)
Knee pain localization (anterior, internal, posterior, lateral, medial)	2, 12, 24 and 48 postoperative hours
Popliteal plexus block procedure time (minutes)	When performing the popliteal plexus block	Onset of action = beginning of the disinfection; End of action = end of injection of 15 mls of Ropivacain 0.5%
Total iv morphine consumption (mg)	24 and 48 postoperative hours
Plantarflexion and dorsiflexion ankle strength (Newtons)	2 and 24 postoperative hours
Sciatic extension of popliteal plexus block	2 and 24 postoperative hours	Presence of sensitive or/and motor sciatic extension of popliteal plexus block

Trial Locations

Locations (1)

Departement of Anesthesia, Hôpitaux Universitaires de Genève; 🇨🇭 Geneva, Switzerland