Nerve Block Techniques for Postoperative Pain from Knee Surgery
Trial Summary
Will I have to stop taking my current medications?
The trial protocol does not specify whether you need to stop taking your current medications. However, if you are taking more than 60 mg of morphine daily for chronic pain, you would not be eligible to participate.
What data supports the effectiveness of the treatment Femoral Triangle Block (FTB) and related techniques for postoperative pain from knee surgery?
Research shows that the Femoral Triangle Block (FTB) can provide effective pain relief after knee surgery while preserving muscle strength better than other techniques like the femoral nerve block. Combining FTB with other nerve blocks, such as the anterior femoral cutaneous nerve block, can further reduce pain during movement in the early postoperative period.12345
Is the Femoral Triangle Block (FTB) safe for use in humans?
The Femoral Triangle Block (FTB) is generally considered safe for use in humans, as it is designed to provide pain relief while minimizing muscle weakness compared to other nerve block techniques. However, like any medical procedure, it may have some risks, such as temporary muscle weakness, which should be discussed with a healthcare provider.12346
How is the femoral triangle block treatment different from other treatments for knee surgery pain?
The femoral triangle block (FTB) is unique because it provides pain relief after knee surgery while preserving muscle strength, unlike the femoral nerve block which can cause significant quadriceps weakness. FTB is administered using ultrasound guidance, which helps target the nerves more precisely, reducing the risk of muscle weakness.12378
What is the purpose of this trial?
Total knee replacement surgery can be associated with a significant postoperative pain burden and an inability to mobilize adequately, which can lead to the failure of the ambulatory course.Indeed, early mobilization is beneficial in this context in order to prevent complications related to immobility.The optimization of postoperative analgesia is therefore a key issue for the success of this intervention in an outpatient setting or during a short-term hospitalization since an adequate pain relief facilitate the earlier mobilization of the operated joint. Modern postoperative analgesia protocols recommend a multimodal approach, including the use of acetaminophen, anti-inflammatories, opioids and others as well as the use of nerve blocks.Some nerve blocks used for total knee replacement surgery, such as the femoral nerve block, do not preserve the motor skills of the operated limb, which may alter the clinical trajectory due to delayed mobilization due to weakening of the quadriceps, one of the extensor muscles of the knee. Currently, one of the blocks used to spare the motor functions is the block of the femoral triangle.Unfortunately, this block of the femoral triangle does not fully cover the skin component of the surgical incision used for a total knee arthroplasty. A solution to obtain a better quality of pain relief at the level of the cutaneous incision would be to add a block of the para-sartorial compartment, which makes it possible to cover the nerve territories not covered by the femoral triangle block.The hypothesis of this study is that the addition of the para-sartorial compartments (PACS) block, which aims to block the intermediate cutaneous femoral nerve, will improve the postoperative analgesia after total knee replacement surgery, compared to the classical isolated approach of the femoral triangle block (FTB).
Research Team
Maxim Roy, MD, FRCPC
Principal Investigator
Centre hospitalier de l'Université de Montréal (CHUM)
Eligibility Criteria
This trial is for adults over 18 needing a primary total knee replacement, with an 'American Society of Anesthesiologists' classification of 1 to 3. It's not for those who can't consent or communicate with the team, don't understand instructions, are pregnant, weigh under 50 kg, have contraindications to nerve blocks or take daily pain meds equivalent to more than 60 mg of morphine.Inclusion Criteria
Exclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive nerve blocks including the femoral triangle block and potentially additional blocks for postoperative analgesia after knee replacement surgery
Immediate Postoperative Monitoring
Participants are monitored for pain levels, complications, and recovery quality within the first 24 hours after surgery
Follow-up
Participants are monitored for pain intensity, quality of recovery, and patient satisfaction up to 7 days after surgery
Treatment Details
Interventions
- Femoral Triangle Block (FTB)
- Infiltration between Popliteal Artery and Capsule of the Knee Block (IPACK)
- Para-Sartorial Compartments (PACS) Block
Find a Clinic Near You
Who Is Running the Clinical Trial?
Centre hospitalier de l'Université de Montréal (CHUM)
Lead Sponsor