Quadriblock Versus "IPACK + Femoral Triangle Block + Obturator Nerve Block" in Total Knee Arthroplasty
NCT ID: NCT04499716
Last Updated: 2021-06-07
Study Results
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Basic Information
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COMPLETED
NA
90 participants
INTERVENTIONAL
2020-12-08
2021-05-07
Brief Summary
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Postoperative pain management requires multimodal analgesia, combining drugs and injection of a local anesthetic (LA). For optimal pain management, several peripheral nerve blocks should be associated. Thus, a recent study shows that the combination of IPACK, femoral triangle and obturator nerve blocks (ITO blocks) provides an effective pain control after TKA.
The hypothesis of this study is that a quadruple nerve block combining femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks (quadri-block) could improve analgesia after TKA.
The main objective of this monocenter, prospective, randomized, open-label, controlled trial is to assess the effect of quadri-block on morphine consumption after TKA compared to ITO blocks.
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Detailed Description
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The patients will be then randomized in 2 groups:
* ITO group (usual technique): IPACK combined to femoral triangle and obturator nerve blocks
* Quadriblock group (experimental technique): femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks.
An experienced anesthetist will perform ultrasound-guided blocks 30 minutes before surgery with ropivacaine 0.3%, total volume of 70 ml.
In the operating room, general anesthesia will be induced by intravenous ketamine (0.4 mg/kg) and propofol (3 mg/kg). Anesthesia will be maintained with propofol.
Postoperative analgesia protocol :
* Multimodal analgesia will be instituted from the end of the surgery by the administration of paracetamol (1 g) and ketoprofen (100 mg).
* In post-anesthesia care unit (PACU): oxynorm titration if VRS (pain score) \>3 according to the centre's usual care.
* In ward: systematic per os analgesia with paracetamol (1 g, 4 times a day) and ibuprofen (400 mg, 3 times a day); oxynorm (10 mg, lockout interval: 4 h) if VRS (pain score) \>3.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
OTHER
DOUBLE
Study Groups
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Arm 1: ITO group
Arm 1: IPACK combined with femoral triangle and obturator nerve blocks
IPACK
25 milliliters of ropivacaine 0.3% will be injected between popliteal artery and femur.
Femoral triangle block
25 milliliters of ropivacaine 0.3% will be injected on the lateral side of the femoral artery at the distal part of the femoral triangle.
Obturator nerve block
20 milliliters of ropivacaine 0.3% will be injected between the adductor magnus and adductor brevis muscles and between the adductor brevis muscle the pectineus.
Arm 2 : Quadri-block group
Arm 2 : Femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks
Obturator nerve block
20 milliliters of ropivacaine 0.3% will be injected between the adductor magnus and adductor brevis muscles and between the adductor brevis muscle the pectineus.
Femoral nerve block
20 milliliters of ropivacaine 0.3% will be injected in supine position under the fascia iliaca lateral to the femoral artery.
Sciatic nerve block
25 milliliters of ropivacaine 0.3% will be injected in prone position in the subgluteal space by lateral approach.
Lateral femoral cutaneous nerve block
5 milliliters of ropivacaine 0.3% will be injected laterally to the sartorius muscle.
Interventions
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IPACK
25 milliliters of ropivacaine 0.3% will be injected between popliteal artery and femur.
Femoral triangle block
25 milliliters of ropivacaine 0.3% will be injected on the lateral side of the femoral artery at the distal part of the femoral triangle.
Obturator nerve block
20 milliliters of ropivacaine 0.3% will be injected between the adductor magnus and adductor brevis muscles and between the adductor brevis muscle the pectineus.
Femoral nerve block
20 milliliters of ropivacaine 0.3% will be injected in supine position under the fascia iliaca lateral to the femoral artery.
Sciatic nerve block
25 milliliters of ropivacaine 0.3% will be injected in prone position in the subgluteal space by lateral approach.
Lateral femoral cutaneous nerve block
5 milliliters of ropivacaine 0.3% will be injected laterally to the sartorius muscle.
Eligibility Criteria
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Inclusion Criteria
* Primary total knee arthroplasty
* Consent for participation,
* Affiliation to a social security system
Exclusion Criteria
* Chronic pain syndrome
* Contraindication to any drugs used in the protocol (paracetamol, ketoprofen, oxynorm, propofol, ketamine, ropivacaine)
* Valgus \> 9°
* Pregnant or breastfeeding women
* Patients under protection of the adults (guardianship, curators or safeguard of justice)
18 Years
ALL
No
Sponsors
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Clinique Medipole Garonne
OTHER
Responsible Party
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Locations
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Clinique Médipôle Garonne
Toulouse, Haute-Garonne, France
Countries
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References
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Marty P, Chassery C, Rontes O, Vuillaume C, Basset B, Merouani M, Marquis C, De Lussy A, Ferre F, Naudin C, Joshi GP, Delbos A. Combined proximal or distal nerve blocks for postoperative analgesia after total knee arthroplasty: a randomised controlled trial. Br J Anaesth. 2022 Sep;129(3):427-434. doi: 10.1016/j.bja.2022.05.024. Epub 2022 Jun 28.
Other Identifiers
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2020/04
Identifier Type: -
Identifier Source: org_study_id
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