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Local Infiltration Analgesia Versus Quadruple Nerve Blocks in Total Knee Arthroplasty.

ConditionTotal Knee Arthroplasty
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorCMC Ambroise Paré

About this trial

Total knee arthroplasty (TKA) is one of the most common orthopedic surgical procedures and is associated with severe pain in the immediate postoperative period, thus limiting early recovery.

Optimal postoperative pain management after TKA is not fully defined. While multimodal analgesia is standard, the choice of associated regional anesthesia techniques is debated.

Local infiltration analgesia (LIA) is widely used and provides effective pain relief without impairing early mobilization.

Peripheral nerve blocks have been discussed due to the risk of motor blockade, but low-concentration local anesthetics, such as 0.1% ropivacaine, allow sensory blockade while preserving motor function. Preliminary studies suggest that this concentration is effective and safe.

The main objective of this monocenter, prospective, randomized, open-label, controlled trial is to compare the analgesic efficacy of a quadruple nerve blocks (femoral, sciatic, obturator, and lateral femoral cutaneous nerves) using 0.1% ropivacaine versus standard LIA in patients undergoing TKA.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Patients undergoing primary total knee arthroplasty under general anesthesia (laryngeal mask airway)

Fully autonomous at home

Planned discharge to home

Consent for participation

Disqualifiers

Preoperative opioid use

Chronic pain syndrome

Valgus contraindicating sciatic nerve block

Contraindication to any drugs used in the protocol

Trial design

Design model

Parallel

Treatments tested in this trial

  • Surgical local infiltration

    Procedure/Surgery

    Injection of 150 mL of ropivacaine 0.2% into periarticular tissues according to a standardized sequence, including the posterior capsule, collateral ligaments, quadriceps, patellar tendon, capsule and subcutaneous tissue before wound closure

  • Obturator nerve block

    Procedure/Surgery

    Injection of 20 mL of 0.1% ropivacaine between the adductor magnus and adductor brevis muscles and between the adductor brevis and pectineus muscles

  • Femoral nerve block

    Procedure/Surgery

    Injection of 15 mL of 0.1% ropivacaine under the fascia iliaca, with the patient in supine position

  • Sciatic nerve block

    Procedure/Surgery

    Injection of 20 mL of 0.1% ropivacaine in the subgluteal space via a lateral approach, with the patient in prone position

  • Lateral femoral cutaneous nerve block

    Procedure/Surgery

    Injection of 5 mL of 0.1% ropivacaine lateral to the sartorius muscle

Treatment groups

80 Participants
are divided into 2 treatment groups
Group A: LIA groupActive comparator 1 intervention
Group B: Quadruple nerve blocks groupExperimental treatment 4 interventions

Trial outcomes

Primary outcomes

1

Total opioid consumption within 24 hours

Total cumulative opioid consumption during the first 24 hours, expressed in oral morphine equivalents (OME, mg), including intraoperative and postoperative opioid administration.

Time frame
From start of surgery (t0) to 24 hours postoperatively

Secondary outcomes

1

Intraoperative anesthetic consumption

Total intraoperative consumption of propofol (mg)

Time frame
During surgery
2

Intraoperative opioid consumption

Total intraoperative consumption of sufentanil (µg)

Time frame
During surgery
3

Intraoperative hypertension events

Occurrence of intraoperative hypertension episodes defined as systolic blood pressure \>160 mmHg

Time frame
During surgery
4

Intraoperative hypotension events

Occurrence of intraoperative hypotension episodes defined as systolic blood pressure \<90 mmHg

Time frame
During surgery

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

CMC Ambroise Paré

Lead sponsor

Source ClinicalTrials.gov
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