Saphenous Nerve Block Versus Femoral Nerve Block for Total Knee Arthroplasty
| Status: | Completed |
|---|---|
| Conditions: | Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 18 - 90 |
| Updated: | 12/20/2017 |
| Start Date: | March 2011 |
| End Date: | November 2011 |
Saphenous (Adductor Canal) Nerve Block Versus Femoral Nerve Block for Total Knee Arthroplasty: A Novel Approach for Postoperative Analgesia
Currently, the regional anesthetic standard of care for total knee replacement surgery is
combined spinal/epidural, with or without a femoral nerve block, or FNB. Lasting
approximately 18 hours, the FNB works by numbing the femoral nerve (and its branches), which
is the major nerve controlling the knee joint. The femoral nerve also provides movement and
sensation. While this regional anesthetic technique offers significant postoperative pain
relief, it is possible that it may cause muscle weakness and increase patients' recovery
time. Hence there is a need for an alternative technique, one that may help minimize
postoperative pain as effectively as the FNB, while not causing weakness of the quadriceps
muscle.
The saphenous nerve, a branch of the femoral nerve, provides sensation to the knee. Thus it
is hypothesized that by "blocking" or anesthetizing the saphenous nerve with local anesthetic
closer to where it branches off, the area around and below the knee will feel numb. Yet
unlike with the FNB, the quadriceps muscle itself will still be able to function.
Patients will be randomized to receive FNB or saphenous nerve block. Quadriceps strength will
be tested using a dynamometer before surgery (baseline), 6-8 hours following anesthesia
administration, and on postoperative days 1 and 2. It is hypothesized that patients who
receive FNB will experience a 50% decrease in quadriceps strength compared to baseline.
combined spinal/epidural, with or without a femoral nerve block, or FNB. Lasting
approximately 18 hours, the FNB works by numbing the femoral nerve (and its branches), which
is the major nerve controlling the knee joint. The femoral nerve also provides movement and
sensation. While this regional anesthetic technique offers significant postoperative pain
relief, it is possible that it may cause muscle weakness and increase patients' recovery
time. Hence there is a need for an alternative technique, one that may help minimize
postoperative pain as effectively as the FNB, while not causing weakness of the quadriceps
muscle.
The saphenous nerve, a branch of the femoral nerve, provides sensation to the knee. Thus it
is hypothesized that by "blocking" or anesthetizing the saphenous nerve with local anesthetic
closer to where it branches off, the area around and below the knee will feel numb. Yet
unlike with the FNB, the quadriceps muscle itself will still be able to function.
Patients will be randomized to receive FNB or saphenous nerve block. Quadriceps strength will
be tested using a dynamometer before surgery (baseline), 6-8 hours following anesthesia
administration, and on postoperative days 1 and 2. It is hypothesized that patients who
receive FNB will experience a 50% decrease in quadriceps strength compared to baseline.
Inclusion Criteria:
- All patients ages 18-90 undergoing primary unilateral total knee arthroplasty
- Planned use of neuraxial anesthesia
- Ability to follow study protocol
- American Society of Anesthesiology (ASA) Class 1-3
Exclusion Criteria:
- Contraindication to a spinal or epidural anesthetic
- Chronic opioid use (defined as daily or almost daily use of opioids for >3 months)
- Hypersensitivity and/or allergy to local anesthetics
- Intraoperative use of any volatile anesthetic
- Patients with a pre-existing neuropathy on the operative limb
- Contraindication to a femoral nerve block or saphenous nerve block
- Allergy to any of the study medications
- Non-English speaking patients
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