Analgesic Efficacy of Anterior Femoral, Genicular and Adductor Canal Nerve Block
| Status: | Recruiting |
|---|---|
| Conditions: | Post-Surgical Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - 90 |
| Updated: | 3/14/2019 |
| Start Date: | October 1, 2017 |
| End Date: | December 2019 |
| Contact: | Roya Yumul, M.D.,PhD. |
| Email: | Roya.Yumul@cshs.org |
| Phone: | 310-423-5841 |
Randomized, Double-Blinded Study to Evaluate the Analgesic Efficacy of Anterior Femoral Cutaneous Nerve Block and/or Genicular Nerve Block When Combined With Adductor Canal (Saphenous) Nerve Block After Total Knee Arthroplasty
Recently, more distal approach to femoral nerve branches (saphenous) in the adductor canal in
the medial compartment of the thigh have shown to provide comparable anesthesia and analgesia
without quadriceps muscle weakness than traditional femoral nerve blocks (FNB) after total
knee arthroplasty (TKA). Adductor canal block (ACB) has the unique advantage of providing
localized analgesia to the peripatellar and intra-articular aspects of the knee joint without
reducing the patient's ability to perform a straight leg raise. However, it does not
adequately address the incisional pain component on the anterior surface of the knee
innervated by anterior femoral cutaneous nerve. This pain may be improved by addition of the
anterior femoral block (AFB). Additionally, the ACB does not provide analgesia to the
posterior aspect of the knee, which is commonly moderate to severe after surgery. This pain
may be decreased by addition of the genicular block, also known as the iPACK block
(interspace between the popliteal artery and the capsule of the knee). There is no study that
has evaluated the potentially analgesic benefits of the AFB or the iPACK block combined with
ACB after TKA. Therefore, the investigators designed this randomized, prospective, and
double-blinded study to assess our hypothesis that the addition of the AFB and/or iPACK block
to the ACB will improve analgesic effects, decrease pain scores, deceased opioid requirement,
and as well as facilitate early recovery and improve patient satisfaction with pain
management in patient after TKA.
the medial compartment of the thigh have shown to provide comparable anesthesia and analgesia
without quadriceps muscle weakness than traditional femoral nerve blocks (FNB) after total
knee arthroplasty (TKA). Adductor canal block (ACB) has the unique advantage of providing
localized analgesia to the peripatellar and intra-articular aspects of the knee joint without
reducing the patient's ability to perform a straight leg raise. However, it does not
adequately address the incisional pain component on the anterior surface of the knee
innervated by anterior femoral cutaneous nerve. This pain may be improved by addition of the
anterior femoral block (AFB). Additionally, the ACB does not provide analgesia to the
posterior aspect of the knee, which is commonly moderate to severe after surgery. This pain
may be decreased by addition of the genicular block, also known as the iPACK block
(interspace between the popliteal artery and the capsule of the knee). There is no study that
has evaluated the potentially analgesic benefits of the AFB or the iPACK block combined with
ACB after TKA. Therefore, the investigators designed this randomized, prospective, and
double-blinded study to assess our hypothesis that the addition of the AFB and/or iPACK block
to the ACB will improve analgesic effects, decrease pain scores, deceased opioid requirement,
and as well as facilitate early recovery and improve patient satisfaction with pain
management in patient after TKA.
Postoperative pain associated with total knee arthroplasty (TKA) can pose significant
challenges in the recovery process of the patients undergoing this procedure. Traditionally,
opioids have played a significant role in treating postoperative pain. It is well established
that opioids are highly effective in relieving pain at rest, but are less effective in
relieving pain associated with motion (e.g. ambulation, passive motion, and physical
rehabilitation). Furthermore, the use of opioids for analgesia is associated with well-known
side effects (such as: nausea, vomiting, constipation, ileus, bladder dysfunction,
respiratory depression, pruritus, drowsiness, sedation, and allergic reaction). These opioid
side effects, which range in severity, can significantly interfere with the rehabilitation
process and contribute to a delay in hospital discharge.
Significant interest exists in the application of regional anesthetic techniques as an
adjuvant to traditional opioid analgesics for pain control in patients after TKA.
Specifically, the incorporation of femoral nerve blocks (FNB) as an adjunct in postoperative
pain control has been widely reported in the anesthesia literature. While it has shown to be
effective in post-operative pain control, it has introduced additional challenges for
physical therapy and raised new concerns regarding the associated quadriceps muscle weakness.
Until adequate quadriceps function returns, the need for knee immobilization devices to
protect patients with traditional FNB from falls interferes with the early recovery process
and the achievement of physical therapy milestones.
challenges in the recovery process of the patients undergoing this procedure. Traditionally,
opioids have played a significant role in treating postoperative pain. It is well established
that opioids are highly effective in relieving pain at rest, but are less effective in
relieving pain associated with motion (e.g. ambulation, passive motion, and physical
rehabilitation). Furthermore, the use of opioids for analgesia is associated with well-known
side effects (such as: nausea, vomiting, constipation, ileus, bladder dysfunction,
respiratory depression, pruritus, drowsiness, sedation, and allergic reaction). These opioid
side effects, which range in severity, can significantly interfere with the rehabilitation
process and contribute to a delay in hospital discharge.
Significant interest exists in the application of regional anesthetic techniques as an
adjuvant to traditional opioid analgesics for pain control in patients after TKA.
Specifically, the incorporation of femoral nerve blocks (FNB) as an adjunct in postoperative
pain control has been widely reported in the anesthesia literature. While it has shown to be
effective in post-operative pain control, it has introduced additional challenges for
physical therapy and raised new concerns regarding the associated quadriceps muscle weakness.
Until adequate quadriceps function returns, the need for knee immobilization devices to
protect patients with traditional FNB from falls interferes with the early recovery process
and the achievement of physical therapy milestones.
Inclusion Criteria:
1. Age 18-90 yrs
2. The American Society of Anesthesiologists (ASA) Physical Status 1-3
3. Either gender
Exclusion Criteria:
1. Refusal to participate in the study
2. Age< 18 yrs, or> 90 yrs
3. General anesthesia
4. Bilateral TKA, or revision of TKA
5. Contraindications to regional blockage including but not limited to:
- Patient refusal to regional blockade
- Infection at the site of needle insertion
- Systemic infection
- Bleeding diathesis or coagulopathy (as diagnosed by history or laboratory
evaluation)
We found this trial at
1
site
8700 Beverly Blvd # 8211
Los Angeles, California 90048
Los Angeles, California 90048
(1-800-233-2771)
Phone: 310-423-5841
Cedars Sinai Med Ctr Cedars-Sinai is known for providing the highest quality patient care. Our...
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