Femoral Triangle Block: Early Mobilization and Postoperative Analgesia After Total Knee Arthroplasty

NCT ID: NCT03518450

Last Updated: 2020-01-22

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

COMPLETED

Clinical Phase

NA

Total Enrollment

78 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-04-01

Study Completion Date

2019-10-15

Brief Summary

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The objective of this trial is to compare the efficacy of three different nerve blocks as an analgesic option after total knee arthroplasty (TKA), based on muscle strength, mobilization and pain.

The Adductor Canal Block has been proposed as an equally effective technique to the Femoral Nerve Block in terms of pain control after a TKA, with the benefit of preserving muscle function. We hypothesize that a block performed at the apex of the femoral triangle would best balance analgesia with quadriceps function.

Detailed Description

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Conditions

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Arthroplasty, Replacement, Knee Anesthesia, Conduction Pain, Postoperative Ultrasonography, Interventional

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Femoral Nerve Block

Ultrasound guided femoral nerve block, 30 ml of 0.25% bupivacaine and 4 mg of dexamethasone to be administered.

Group Type ACTIVE_COMPARATOR

Femoral Nerve Block

Intervention Type PROCEDURE

Regional anesthetic technique that blocks the sensory and motor information of the femoral nerve (and it's branches).

Adductor Canal Block

Ultrasound guided adductor canal block, at the proximal third of the canal, 30 ml of 0.25% bupivacaine and 4 mg of dexamethasone to be administered.

Group Type ACTIVE_COMPARATOR

Adductor Canal Block

Intervention Type PROCEDURE

Interfascial block that targets mainly the saphenous nerve.

Apex Femoral Triangle Block

Ultrasound guided femoral triangle block, at the distal third of the triangle, 30 ml of 0.25% bupivacaine and 4 mg of dexamethasone to be administered.

Group Type EXPERIMENTAL

Apex Femoral Triangle Block

Intervention Type PROCEDURE

Nerve block that aims the vastus medialis nerve, the saphenous nerve and the anterior femoral cutaneous nerve.

Interventions

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Apex Femoral Triangle Block

Nerve block that aims the vastus medialis nerve, the saphenous nerve and the anterior femoral cutaneous nerve.

Intervention Type PROCEDURE

Femoral Nerve Block

Regional anesthetic technique that blocks the sensory and motor information of the femoral nerve (and it's branches).

Intervention Type PROCEDURE

Adductor Canal Block

Interfascial block that targets mainly the saphenous nerve.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Subjects of any gender, from 18 to 90 years old that accept to participate in the study.
* Programmed primary total knee arthroplasty surgery

Exclusion Criteria

* Emergent surgery
* Reinterventions
* Unstable psychiatric pathology, dementia
* Kidney or hepatic disease that contraindicates the use of NSAIDs and/or Paracetamol.
* Allergy to amides local anesthesics, NSAIDs, opioids and/or Paracetamol.
* Daily use of opioids greater than 30 mg of morphine (or equivalent)
* Patients under 18 or over 90 years old.
* Drug abuse
* Rejection to be a participant of the study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Universitari Vall d'Hebron Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Alfons Biarnes Suñe, M.D., Ph.D.

Role: STUDY_DIRECTOR

Carlos I Salvadores de Arzuaga, M.D.

Role: PRINCIPAL_INVESTIGATOR

Locations

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Hospital Universitari Vall d'Hebron

Barcelona, , Spain

Site Status

Countries

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Spain

References

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Danninger T, Opperer M, Memtsoudis SG. Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks. World J Orthop. 2014 Jul 18;5(3):225-32. doi: 10.5312/wjo.v5.i3.225. eCollection 2014 Jul 18.

Reference Type BACKGROUND
PMID: 25035824 (View on PubMed)

Dong CC, Dong SL, He FC. Comparison of Adductor Canal Block and Femoral Nerve Block for Postoperative Pain in Total Knee Arthroplasty: A Systematic Review and Meta-analysis. Medicine (Baltimore). 2016 Mar;95(12):e2983. doi: 10.1097/MD.0000000000002983.

Reference Type BACKGROUND
PMID: 27015172 (View on PubMed)

Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, Murthy Y. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010 Nov;113(5):1144-62. doi: 10.1097/ALN.0b013e3181f4b18.

Reference Type BACKGROUND
PMID: 20966667 (View on PubMed)

Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, Criswell A. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001 Jun;16(4):436-45. doi: 10.1054/arth.2001.23622.

Reference Type BACKGROUND
PMID: 11402405 (View on PubMed)

Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010 Jan;468(1):135-40. doi: 10.1007/s11999-009-1025-1. Epub 2009 Aug 13.

Reference Type BACKGROUND
PMID: 19680735 (View on PubMed)

Burckett-St Laurant D, Peng P, Giron Arango L, Niazi AU, Chan VW, Agur A, Perlas A. The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study. Reg Anesth Pain Med. 2016 May-Jun;41(3):321-7. doi: 10.1097/AAP.0000000000000389.

Reference Type BACKGROUND
PMID: 27015545 (View on PubMed)

Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J, Oldfield S, Oh J, Brull R. Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction. Anesthesiology. 2016 May;124(5):1053-64. doi: 10.1097/ALN.0000000000001045.

Reference Type BACKGROUND
PMID: 26938989 (View on PubMed)

Elkassabany NM, Antosh S, Ahmed M, Nelson C, Israelite C, Badiola I, Cai LF, Williams R, Hughes C, Mariano ER, Liu J. The Risk of Falls After Total Knee Arthroplasty with the Use of a Femoral Nerve Block Versus an Adductor Canal Block: A Double-Blinded Randomized Controlled Study. Anesth Analg. 2016 May;122(5):1696-703. doi: 10.1213/ANE.0000000000001237.

Reference Type BACKGROUND
PMID: 27007076 (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)

Kardash KJ, Noel GP. The SPANK Block: A Selective Sensory, Single-Injection Solution for Posterior Pain After Total Knee Arthroplasty. Reg Anesth Pain Med. 2016 Jan-Feb;41(1):118-9. doi: 10.1097/AAP.0000000000000330. No abstract available.

Reference Type BACKGROUND
PMID: 26678763 (View on PubMed)

Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013 Feb;118(2):409-15. doi: 10.1097/ALN.0b013e318279fa0b.

Reference Type BACKGROUND
PMID: 23241723 (View on PubMed)

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)

de Arzuaga CIS, Miguel M, Biarnes A, Garcia M, Naya J, Khoudeir A, Minguell J, Pujol O. Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial. Arch Orthop Trauma Surg. 2023 Nov;143(11):6763-6771. doi: 10.1007/s00402-023-04960-5. Epub 2023 Jun 30.

Reference Type DERIVED
PMID: 37391523 (View on PubMed)

Other Identifiers

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PR(AG)299/2017

Identifier Type: -

Identifier Source: org_study_id

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