Popliteal Plexus Block for Total Knee Arthroplasty

NCT ID: NCT03439787

Last Updated: 2019-04-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

15 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-15

Study Completion Date

2018-08-23

Brief Summary

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This study aims to assess the analgesic effect of the popliteal plexus block as a supplement to a femoral triangle block in patients undergoing total knee arthroplasty

Detailed Description

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A femoral triangle block (FTB) effectively anesthetizes the anterior group of nerves innervating the knee (infrapatellar branch of the saphenous nerve, the medial femoral cutaneous nerve and the terminal branch of the medial vastus muscle nerve). However, the posterior group of nerves innervating the knee joint is not covered with an FTB, and therefore most patients complain of significant, opioid-requiring pain despite a successful FTB.

The posterior group consists of the popliteal plexus, which is derived from the tibial nerve and the posterior branch of the obturator nerve. The popliteal plexus is located in the popliteal fossa, where it entwines the popliteal artery and vein. Recent cadaver studies have suggested that an injection into the distal part of the adductor canal will spread to the popliteal fossa (PubMed Identifier (ID): 28937534; PubMed ID: 27442773).

This study aims to assess the analgesic effect of the popliteal plexus block (PPB) as a supplement to a femoral triangle block (FTB) after total knee arthroplasty (TKA).

In the study all patients will receive an FTB with 10 ml bupivacaine-epinephrine (0.5%-1:200,000) with the addition of 0.5 ml Dexamethasone (4 mg/ml).

All patients are postoperatively observed for the development of significant pain (NRS \> 3) in the primary observation period (POP) defined as: a 3-hour observation period starting at the return of completely normal cutaneous sensation (lateral thigh and lateral side of the lower leg) after spinal anesthesia. If the patient reports pain (NRS \> 3) in the POP, the patient will be randomized to the study treatment - a PPB with 10 ml bupivacaine-epinephrine or 10 ml saline.

Conditions

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Pain, Postoperative

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized, placebo-controlled, double-blinded design
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Active Popliteal Plexus Block

10 ml Bupivacaine-Epinephrine 0.5%-1:200,000 Injectable Solution

Group Type ACTIVE_COMPARATOR

Bupivacaine-EPINEPHrine 0.5%-1:200,000 Injectable Solution

Intervention Type DRUG

10 ml

Placebo Popliteal Plexus Block

10 ml Sodium Chloride 0.9 %

Group Type PLACEBO_COMPARATOR

Sodium Chloride 0.9 %

Intervention Type OTHER

10 ml

Interventions

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Bupivacaine-EPINEPHrine 0.5%-1:200,000 Injectable Solution

10 ml

Intervention Type DRUG

Sodium Chloride 0.9 %

10 ml

Intervention Type OTHER

Other Intervention Names

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Marcain-adrenaline

Eligibility Criteria

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Inclusion Criteria

* Male or female at least 50 years of age at screening
* Scheduled to undergo primary total knee arthroplasty in spinal anesthesia
* Normal sensory function at the lateral part of the thigh and lower leg
* American Society of Anesthesiologists (ASA) physical status 1, 2, or 3
* Able to provide informed consent

Exclusion Criteria

* Unable to cooperate and follow the study protocol
* Communication problems
* Allergic towards any medical product administered in the study
* Diabetes requiring medical treatment
* Pregnancy (a pregnancy test will be conducted on all women of childbearing potential prior to inclusion in the study. A positive test result will result in exclusion from the study)
* Preoperative opioid treatment (dosed \> once daily)
Minimum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Aarhus

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Charlotte R Sørensen, MD

Role: PRINCIPAL_INVESTIGATOR

Silkeborg Regional Hospital

Locations

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Silkeborg Regional Hospital

Silkeborg, , Denmark

Site Status

Countries

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Denmark

References

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Bendtsen TF, Moriggl B, Chan V, Borglum J. The Optimal Analgesic Block for Total Knee Arthroplasty. Reg Anesth Pain Med. 2016 Nov/Dec;41(6):711-719. doi: 10.1097/AAP.0000000000000485.

Reference Type BACKGROUND
PMID: 27685346 (View on PubMed)

Wong WY, Bjorn S, Strid JM, Borglum J, Bendtsen TF. Defining the Location of the Adductor Canal Using Ultrasound. Reg Anesth Pain Med. 2017 Mar/Apr;42(2):241-245. doi: 10.1097/AAP.0000000000000539.

Reference Type BACKGROUND
PMID: 28002228 (View on PubMed)

GARDNER E. The innervation of the knee joint. Anat Rec. 1948 May;101(1):109-30. doi: 10.1002/ar.1091010111. No abstract available.

Reference Type BACKGROUND
PMID: 18915634 (View on PubMed)

Abdallah FW, Chan VW, Gandhi R, Koshkin A, Abbas S, Brull R. The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial. Anesthesiology. 2014 Dec;121(6):1302-10. doi: 10.1097/ALN.0000000000000406.

Reference Type BACKGROUND
PMID: 25099748 (View on PubMed)

Abdallah FW, Madjdpour C, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis. Can J Anaesth. 2016 May;63(5):552-68. doi: 10.1007/s12630-016-0613-2. Epub 2016 Feb 19.

Reference Type BACKGROUND
PMID: 26896282 (View on PubMed)

Runge C, Borglum J, Jensen JM, Kobborg T, Pedersen A, Sandberg J, Mikkelsen LR, Vase M, Bendtsen TF. The Analgesic Effect of Obturator Nerve Block Added to a Femoral Triangle Block After Total Knee Arthroplasty: A Randomized Controlled Trial. Reg Anesth Pain Med. 2016 Jul-Aug;41(4):445-51. doi: 10.1097/AAP.0000000000000406.

Reference Type BACKGROUND
PMID: 27171822 (View on PubMed)

McNamee DA, Parks L, Milligan KR. Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block. Acta Anaesthesiol Scand. 2002 Jan;46(1):95-9. doi: 10.1034/j.1399-6576.2002.460117.x.

Reference Type BACKGROUND
PMID: 11903080 (View on PubMed)

Taha AM. Brief reports: ultrasound-guided obturator nerve block: a proximal interfascial technique. Anesth Analg. 2012 Jan;114(1):236-9. doi: 10.1213/ANE.0b013e318237fb40. Epub 2011 Oct 24.

Reference Type BACKGROUND
PMID: 22025494 (View on PubMed)

Goffin P, Lecoq JP, Ninane V, Brichant JF, Sala-Blanch X, Gautier PE, Bonnet P, Carlier A, Hadzic A. Interfascial Spread of Injectate After Adductor Canal Injection in Fresh Human Cadavers. Anesth Analg. 2016 Aug;123(2):501-3. doi: 10.1213/ANE.0000000000001441.

Reference Type BACKGROUND
PMID: 27442773 (View on PubMed)

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377-81. doi: 10.1016/j.jbi.2008.08.010. Epub 2008 Sep 30.

Reference Type BACKGROUND
PMID: 18929686 (View on PubMed)

Runge C, Moriggl B, Borglum J, Bendtsen TF. The Spread of Ultrasound-Guided Injectate From the Adductor Canal to the Genicular Branch of the Posterior Obturator Nerve and the Popliteal Plexus: A Cadaveric Study. Reg Anesth Pain Med. 2017 Nov/Dec;42(6):725-730. doi: 10.1097/AAP.0000000000000675.

Reference Type BACKGROUND
PMID: 28937534 (View on PubMed)

Related Links

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https://clinicaltrials.gov/ct2/show/NCT03198403?term=NCT03198403&rank=1

The pilot study on which the current study is based

Other Identifiers

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2017-005180-40

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

Protocol_PPB_TKA_31122017

Identifier Type: -

Identifier Source: org_study_id

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