Patient suffer from moderate posterior knee pain after TKA despite injection of local anesthetic around the femoral or saphenous nerves. Indeed, the posterior part of the knee is innervated by the sciatic nerve. This nerve is not routinely blocked as clinicians fear to produce a motor block of the leg that might impair the postoperative assessment. An analgesic alternative is the infiltration of the knee with local anesthetics performed by the surgeon. Recently a trial(1) demonstrated that a selective tibial nerve block provides an effective analgesia without a motor blockage when compared with a sciatic nerve block. The objective of this randomized controlled double-blinded trial is to assess whether a tibial nerve block is more effective for the postoperative pain than local infiltration analgesia when there are combined with an adductor canal block, without decreasing the functional parameters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
60
Tibial nerve block with 10ml of Ropivacaine 0.5%
Infiltration with 25ml of Ropivacaine 0.2% in the posterior knee capsule
Eric Albrecht
Lausanne, English, Switzerland
Total morphine consumption (mg)
Time frame: 24 hours postoperatively
Total morphine consumption (mg)
Time frame: 2 hours, 48 hours and 72 hours postoperatively
Analgesic duration (minutes)
Time from the block to the first analgesic request
Time frame: Postoperative day 0
Pain scores (numeric rating scale, 0-10) at rest and on movement
0= no pain, 10=the worst pain imaginable
Time frame: 2 hours, 24 hours, 48 hours and 72 hours postoperatively
Rate of postoperative nausea and vomiting
Yes/No
Time frame: 2 hours, 24 hours, 48 hours and 72 hours postoperatively
Rate of prurit
Yes/No
Time frame: 2 hours, 24 hours, 48 hours and 72 hours postoperatively
Active flexion
Flexion of the knee by the patient measured in degrees
Time frame: 24hours, 48hours and 72hours postoperatively
Passive flexion
Flexion of the knee by physiotherapist measured in degrees
Time frame: 24hours, 48hours and 72hours postoperatively
Quadriceps muscle strength (numeric scale, 1-5)
1=no contraction, 5=normal strength
Time frame: 24hours, 48hours and 72hours postoperatively
Distance walked (meters)
Time frame: 24hours, 48hours and 72hours postoperatively
Complication of tibial nerve block
Intravascular injection/hematoma/infection/Common peroneal nerve block
Time frame: up to 1 week
Length of stay in hospital
Days
Time frame: up to 14 days
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