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The investigators aimed to evaluate the efficacy of selective low volume ultrasound-guided blockades of the saphenous and obturator nerves on dynamic and rest pain 24-hours post-operatively for patients undergoing unilateral primary total knee arthroplasty.
A femoral nerve block is the recommended strategy in many surgical centers to supplement multimodal analgesic regime following total knee arthroplasty (TKA) (i.e. both for spinal and general anesthesia). However, a femoral nerve block will often result in quadriceps paralysis, and this will increase the risk for the patient to fall as long as the femoral block have effect. Thus, the search for sensory nerve blocks to stop pain after TKA is a very interesting topic. The saphenous nerve is a purely sensory nerve, and the posterior branch of the obturator nerve is a mixed nerve, where the motor component only affects part of the adductor major muscle.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Saphenous and obturator nerve block | Active Comparator | 5 ml of ropivacaine 0.75% for the saphenous nerve and 10 ml of ropivacaine 0,75% for the obturator nerve block. Ropivacaine 0.75% for nerve blockades for both nerves mentioned. |
|
| Saphenous nerve block | Active Comparator | 5 ml of ropivacaine 0.75% for the saphenous nerve and 10 ml of isotonic saline for the obturator nerve block. Ropivacaine 0.75% for the saphenous nerve block and saline for the obturator nerve block |
|
| Placebo nerve block | Placebo Comparator | 5 ml of isotonic saline for the saphenous nerve and 10 ml of isotonic saline for the obturator nerve block. Saline for nerve blockades for both nerves mentioned. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| nerve block with ropivacaine | Drug | Ultrasound guided nerve blocks of the saphenous and obturator nerve, posterior branch with ropivacaine 0.75% for both nerve branches |
|
| Measure | Description | Time Frame |
|---|---|---|
| Dynamic pain (pain upon movement) quantified as area-under-the-curve (AUC) 24-hours post-operatively | NRS 0-10 | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Pain at rest quantified as area-under-the-curve (AUC) 24-hours post-operatively | NRS 0-10 | 24 hours |
| Total opioid consumption | mg | 24 hours |
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Inclusion Criteria:
Exclusion Criteria:
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|
| nerve block with ropivacaine and with saline | Drug | nerve blocks of the saphenous nerve with ropivacaine 0.75% and obturator nerve, posterior branch with saline |
|
|
| nerve block with saline | Drug | Ultrasound guided nerve blocks of the saphenous and obturator nerve, posterior branch with saline for both nerve branches |
|
|
| Nausea and vomiting | NRS 0-10 | 24 hours |
| Time to first mobilization | hours | 24 hours |
| Length of stay in recovery and hospital | hours | 72 hours |
| Number of clinical complications | total number | 72 hours |
| ID | Term |
|---|---|
| D009407 | Nerve Block |
| D000077212 | Ropivacaine |
| D012965 | Sodium Chloride |
| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D003714 | Denervation |
| D019635 | Neurosurgical Procedures |
| D013514 | Surgical Procedures, Operative |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017670 | Sodium Compounds |
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