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

Condition(s) studied

Investigational drug(s) / intervention(s)

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

Sciatic nerve block: 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: Injection of 5 mL of 0.1% ropivacaine lateral to the sartorius muscle

Study summary

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

Primary outcome measure(s)

• Total opioid consumption within 24 hours — From start of surgery (t0) to 24 hours postoperatively
  Total cumulative opioid consumption during the first 24 hours, expressed in oral morphine equivalents (OME, mg), including intraoperative and postoperative opioid administration.

Trial sites (1)

More CMC Ambroise Paré trials in France

Other trials for the same condition