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The study aims to investigate the effect of the popliteal plexus block (PPB) on postoperative pain in patients undergoing anterior cruciate ligament (ACL) reconstruction.
Postoperative pain following ACL reconstruction can be alleviated with an ultrasound-guided femoral triangle block (FTB). However, it is the investigators' observation that 10-20 % of the patients still complain of intense pain localized in the center of the knee.
Cadaver dissection studies have shown that an injection into the distal part of the adductor canal will spread to the popliteal fossa, and one dissection study showed consistent spread to the popliteal plexus.
The study team hypothesized that a PPB will reduce the postoperative pain, when it is used as a supplement to the FTB in patients undergoing ACL reconstruction.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with postoperative pain, NRS >3 | Experimental | Patients reporting postoperative pain (NRS >3) localized to the center of the knee (10 patients) will receive a popliteal plexus block |
|
| Patients with postoperative pain, NRS ≤ 3 | No Intervention | (approx. 90 patients) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Popliteal plexus block | Procedure | 10 mL Marcain-adrenalin 5 mg/mL + 5 microgram/mL. Ultrasound-guided injection into the distal part of the adductor canal |
|
| Measure | Description | Time Frame |
|---|---|---|
| The effect of the popliteal plexus block (PPB) | Evaluated as the percentage of patients with postoperative pain NRS >3, dropping in pain score to NRS ≤ 3 after the PPB | Pain scores (NRS): 15, 30, 45 and 60 minutes after PPB |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of patients with central knee pain | The percentage of patients with FTB reporting pain (NRS >3) localized in the center of the knee in the observation period | Pain scores: 15, 30, 45 and 60 minutes after arrival at the post anesthesia care unit (PACU) |
| Onset time for PPB |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jan M Jensen, MD | Aarhus University Hospital | Principal Investigator |
| Christian Jessen, MD | The Regional Hospital in Horsens | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aarhus University Hospital | Aarhus C | 8000 | Denmark | |||
| The Regional Hospital in Horsens |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28002228 | Background | Wong WY, Bjorn S, Strid JM, Borglum J, Bendtsen TF. Defining the Location of the Adductor Canal Using Ultrasound. Reg Anesth Pain Med. 2017 Mar/Apr;42(2):241-245. doi: 10.1097/AAP.0000000000000539. | |
| 27685346 | Background | Bendtsen TF, Moriggl B, Chan V, Borglum J. The Optimal Analgesic Block for Total Knee Arthroplasty. Reg Anesth Pain Med. 2016 Nov/Dec;41(6):711-719. doi: 10.1097/AAP.0000000000000485. |
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| ID | Term |
|---|---|
| D000070598 | Anterior Cruciate Ligament Injuries |
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
| D011183 | Postoperative Complications |
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Pilot study
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Time from withdrawal of the needle until patient reports NRS ≤ 3 |
| Pain scores (NRS): 15, 30, 45 and 60 minutes after PPB |
| The effect of the PPB on cutaneous sensation | Tested on the lateral part of the lower leg (pinprick test) | Baseline, 30 and 60 minutes after PPB |
| The effect of the PPB on muscle strength | Dorsal flexion and plantar flexion in the ankle joint, measured with a handheld dynamometer) | Baseline, 60 minutes after PPB |
| Horsens |
| 8700 |
| Denmark |
| 25376972 | Background | Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):3-10. doi: 10.1097/AAP.0000000000000169. |
| 27442773 | Background | Goffin P, Lecoq JP, Ninane V, Brichant JF, Sala-Blanch X, Gautier PE, Bonnet P, Carlier A, Hadzic A. Interfascial Spread of Injectate After Adductor Canal Injection in Fresh Human Cadavers. Anesth Analg. 2016 Aug;123(2):501-3. doi: 10.1213/ANE.0000000000001441. |
| D010335 |
| Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |