Popliteal Nerve Block for Achilles Tendon Repair

Overseen By Connor T.A. Brenna, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Toronto

Must not be taking: Oxycodone, Local anesthetics

Disqualifiers: Neurological deficits, Chronic pain, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines the effects of a popliteal nerve block on pain and recovery after surgery to repair a torn Achilles tendon. The goal is to determine if this anesthesia, which numbs the knee area, effectively reduces pain and enhances post-surgery quality of life. Participants will receive either the nerve block or a sham (fake) procedure for comparison. Individuals undergoing surgery for a recent Achilles tendon tear and in good general health may be suitable candidates for this study. As an unphased trial, it offers a unique opportunity to contribute to medical knowledge and potentially improve recovery experiences for future patients.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you are taking over 30 mg of oxycodone or equivalent per day, you may not be eligible to participate.

What prior data suggests that the popliteal nerve block is safe for Achilles tendon repair surgery?

Research shows that popliteal nerve blocks are generally safe, though they carry some risks. Studies have found that about 10.1% of patients experience short-term problems, and 4.3% face long-term issues after receiving this type of nerve block. These problems can include nerve injury, though this is uncommon. One study found that using ultrasound to guide the nerve block enhances safety and effectiveness for post-surgery pain relief. While evidence varies, most patients tolerate popliteal nerve blocks well. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the popliteal nerve block for Achilles tendon repair because it offers a targeted approach to pain management. Unlike standard treatments that rely on general anesthesia or systemic painkillers, this technique focuses on blocking nerve signals specifically in the surgical area, potentially reducing the need for narcotics and their side effects. By using ultrasound guidance to administer the block, it also aims for precision and safety, which could enhance patient recovery and comfort. This approach represents a shift towards more localized, efficient pain control, which is particularly promising for reducing overall medication use and improving outcomes in tendon repair surgeries.

What evidence suggests that a popliteal nerve block is effective for Achilles tendon repair?

Research has shown that a popliteal nerve block, which participants in this trial may receive, can effectively reduce pain after Achilles tendon repair. This anesthesia numbs the area around the popliteal nerve, aiding pain management during and after surgery. Studies have also found that it can shorten anesthesia operation time and speed up recovery. Ultrasound guidance further enhances the nerve block's accuracy and effectiveness. However, risks such as possible nerve injury should be considered when deciding on this treatment. Overall, the popliteal nerve block offers a promising option for pain management in Achilles tendon surgeries. ^{1 2 6 7 8}

Who Is on the Research Team?

Richard Brull, MD FRCPC

Principal Investigator

University Health Network, Toronto

Are You a Good Fit for This Trial?

This trial is for patients undergoing Achilles tendon repair surgery. Participants should be suitable for caudal epidural block therapy or regional anesthesia. Those with a ruptured corpus cavernosum are excluded, ensuring the focus remains on individuals specifically dealing with Achilles tendon issues.

Inclusion Criteria

BMI < 35 kg/m2

My health is good to moderately impaired.

I am having day surgery for an Achilles tendon repair.

Exclusion Criteria

History of use of over 30 mg oxycodone or equivalent per day

History of significant psychiatric conditions that may affect patient assessment

Pregnancy

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Preparation

Patients receive preoperative care including non-invasive monitoring and intravenous midazolam for anxiolysis

1 day

1 visit (in-person)

Surgery and Immediate Postoperative Care

Patients undergo Achilles tendon repair surgery with either a popliteal nerve block or sham block, followed by immediate postoperative care

1 day

1 visit (in-person)

Acute Postoperative Monitoring

Monitoring of pain, recovery, and adverse events in the first 24 hours after surgery

24 hours

Subacute Postoperative Monitoring

Continued monitoring of recovery and adverse events up to one week after surgery

1 week

1 visit (in-person), study diary entries

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 week

What Are the Treatments Tested in This Trial?

Interventions

• Popliteal Nerve Block

Trial Overview The study tests the effectiveness of popliteal nerve blocks in managing postoperative pain and aiding recovery after Achilles tendon repair surgery. It compares real popliteal nerve blocks against sham blocks (placebos) to assess their impact on patient outcomes.

How Is the Trial Designed?

Group I: Popliteal Nerve Block Group Experimental Treatment 1 Intervention

Patients will be randomly assigned to this, or a comparator, group. In accordance with routine pre-block management, non-invasive blood pressure, electrocardiogram, and pulse oximeter will be attached to the patient. A 20G intravenous access will be secured in the upper extremity to begin administering an intravenous infusion of Lactated Ringer's solution. Prior to block performance, all patients will receive intravenous midazolam 1 - 4 mg IV for anxiolysis. In a designated block room, a regional anesthesiologist or anesthesia fellow with experience performing popliteal nerve blocks will sterilize the popliteus of the surgical knee with 2% chlorhexidine swabs, infiltrate it with 2 mL 2% lidocaine, and visualize the underlying anatomy using ultrasound. They will then perform a popliteal nerve block for patients in this group. Patients in both groups will otherwise receive identical preoperative and postoperative care.

Group II: Control Group Placebo Group 1 Intervention

Patients will be randomly assigned to this, or an intervention, group. In accordance with routine pre-block management, non-invasive blood pressure, electrocardiogram, and pulse oximeter will be attached to the patient. A 20G intravenous access will be secured in the upper extremity to begin administering an intravenous infusion of Lactated Ringer's solution. Prior to block performance, all patients will receive intravenous midazolam 1 - 4 mg IV for anxiolysis. In a designated block room, a regional anesthesiologist or anesthesia fellow with experience performing popliteal nerve blocks will sterilize the popliteus of the surgical knee with 2% chlorhexidine swabs, infiltrate it with 2 mL 2% lidocaine, and visualize the underlying anatomy using ultrasound. They will then perform a sham block for patients in this group. Patients in both groups will otherwise receive identical preoperative and postoperative care.

Who Is Running the Clinical Trial?

University of Toronto

Lead Sponsor

Trials

739

Recruited

1,125,000+

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S2667396725000096

Achilles hero or heel? A systematic review of popliteal ... Popliteal nerve block is often performed for pain relief during surgical Achilles repair; however, the evidence basis demonstrating its analgesic effectiveness ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12318936/

Popliteal sciatic nerve block versus intrathecal anesthesia ... Statistical analysis revealed that in terms of anesthesia effectiveness, the BG had a shorter anesthesia operation time (1.95 ± 0.40 min) than ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT06886815

Popliteal Nerve Block for Achilles Tendon Repair Surgery This research study will evaluate the effects of popliteal nerve block on postoperative pain, recovery, and quality of life after Achilles tendon repair surgery ...

4. withpower.com withpower.com/trial/phase-caudal-epidural-block-therapy-8-2025-a5c1a

Popliteal Nerve Block for Achilles Tendon Repair Research shows that using a popliteal nerve block, especially when guided by ultrasound, can effectively reduce pain after Achilles tendon repair. It also ...

5. papers.ssrn.com papers.ssrn.com/sol3/papers.cfm?abstract_id=4923591

Comparative Clinical Application of Popliteal Sciatic Nerve ... The use of popliteal sciatic nerve block in Achilles tendon repair surgery resulted in shorter anesthesia operation time, fewer immediate puncture ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7450881/

Regional Nerve Block Complication Analysis Following ... The overall short-term complication rate was 10.1% and the long-term complication rate was 4.3%, with a total of 855 blocks given.

7. researchgate.net researchgate.net/publication/388425910_Achilles_Hero_or_Heel_A_Systematic_Review_of_Popliteal_Nerve_Block_for_Achilles_Repair

Achilles Hero or Heel? A Systematic Review of Popliteal ... This retrospective study suggests that ultrasound-guided sciatic nerve block in the popliteal fossa provides safe and effective postoperative pain relief after ...

8. fastracjournal.org fastracjournal.org/article/S2667-3967(22)00088-X/fulltext

Nerve injury following popliteal nerve and adductor canal blocks Lauf et al. discovered a short-term complication rate of 10.1% and the long-term complication rate of 4.3%, with a total of 855 blocks given.