Local Infiltration Analgesia Versus Quadruple Nerve Blocks in Total Knee Arthroplasty.

NCT07477730 | Not Yet Recruiting

• 1 other identifier: 2025/02
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Total knee arthroplasty (TKA) is one of the most common orthopedic surgical procedures and is associated with severe pain in the immediate postoperative period, thus limiting early recovery. Optimal postoperative pain management after TKA is not fully defined. While multimodal analgesia is standard, the choice of associated regional anesthesia techniques is debated. Local infiltration analgesia (LIA) is widely used and provides effective pain relief without impairing early mobilization. Peripheral nerve blocks have been discussed due to the risk of motor blockade, but low-concentration local anesthetics, such as 0.1% ropivacaine, allow sensory blockade while preserving motor function. Preliminary studies suggest that this concentration is effective and safe. The main objective of this monocenter, prospective, randomized, open-label, controlled trial is to compare the analgesic efficacy of a quadruple nerve blocks (femoral, sciatic, obturator, and lateral femoral cutaneous nerves) using 0.1% ropivacaine versus standard LIA in patients undergoing TKA.

Conditions

Total Knee Arthroplasty

Keywords

Knee arthroplasty; Local Infiltration Analgesia; Regional anesthesia; Ropivacaine; Postoperative analgesia; Pain management; Opioids

Outcome Measures

Primary Outcomes (1)

• Total opioid consumption within 24 hours

  Total cumulative opioid consumption during the first 24 hours, expressed in oral morphine equivalents (OME, mg), including intraoperative and postoperative opioid administration.

  From start of surgery (t0) to 24 hours postoperatively

Secondary Outcomes (15)

• Intraoperative anesthetic consumption

  During surgery

• Intraoperative opioid consumption

  During surgery

• Intraoperative hypertension events

  During surgery

• Intraoperative hypotension events

  During surgery

• Postoperative pain intensity

  Up to 48 hours postoperatively

Study Arms (2)

LIA group

ACTIVE COMPARATOR

Local infiltration analgesia

Procedure: Surgical local infiltration

Quadruple nerve blocks group

EXPERIMENTAL

Femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks

Procedure: Obturator nerve block; Procedure: Femoral nerve block; Procedure: Sciatic nerve block; Procedure: Lateral femoral cutaneous nerve block

Interventions

Surgical local infiltration PROCEDURE

Injection of 150 mL of ropivacaine 0.2% into periarticular tissues according to a standardized sequence, including the posterior capsule, collateral ligaments, quadriceps, patellar tendon, capsule and subcutaneous tissue before wound closure

LIA group

Obturator nerve block PROCEDURE

Injection of 20 mL of 0.1% ropivacaine between the adductor magnus and adductor brevis muscles and between the adductor brevis and pectineus muscles

Quadruple nerve blocks group

Femoral nerve block PROCEDURE

Injection of 15 mL of 0.1% ropivacaine under the fascia iliaca, with the patient in supine position

Quadruple nerve blocks group

Sciatic nerve block PROCEDURE

Injection of 20 mL of 0.1% ropivacaine in the subgluteal space via a lateral approach, with the patient in prone position

Quadruple nerve blocks group

Lateral femoral cutaneous nerve block PROCEDURE

Injection of 5 mL of 0.1% ropivacaine lateral to the sartorius muscle

Quadruple nerve blocks group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients undergoing primary total knee arthroplasty under general anesthesia (laryngeal mask airway)
• Fully autonomous at home
• Planned discharge to home
• Consent for participation
• Affiliation to a social security system

You may not qualify if:

• Preoperative opioid use
• Chronic pain syndrome
• Valgus contraindicating sciatic nerve block
• Contraindication to any drugs used in the protocol
• Contraindication to laryngeal mask airway
• Pregnant or breastfeeding women
• Patients under protection of the adults (guardianship, curators or safeguard of justice)

Sponsors & Collaborators

• CMC Ambroise Paré: lead

Study Sites (1)

Clinique Médipôle Garonne

Toulouse, Haute-Garonne, 31036, France

Location

MeSH Terms

Conditions

Agnosia

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Philippe MARTY, MD

CONTACT

05 62 13 29 97; philippemarty@hotmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 13, 2026
• First Posted: March 17, 2026
• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): December 2, 2027
• Study Completion (Estimated): February 1, 2028
• Last Updated: March 17, 2026

Record last verified: 2026-03

Locations

FR (1)