Infiltration or Nerve Blocks in Addition to Adductor Canal Block

Comparison of the Benefit of Peripheral Nerve Quadri-block Versus Adductor Canal Block + Surgical Infiltration in Total Knee Arthroplasty

The aim of this study is to evaluate the analgesic efficacy of this quadruple sensory block compared with the currently recommended procedure (adductor canal block + infiltration).

In addition to the adductor canal block, this quadruple block incorporates :

1. the block of the lateral cutaneous nerve of the thigh (or femoral-cutaneous nerve), which is a collateral sensory branch of the posterior part of the lumbar plexus.
2. IPACK (Infiltration between Popliteal Artery and Capsule of Knee), designed as a motor-sparing technique (targeting the sensory articular branches of the sciatic nerve and avoiding the motor branches of the tibial and fibular nerves), is particularly effective on posterior pain.
3. obturator nerve block, a mixed nerve originating from the anterior part of the lumbar plexus. It divides into two branches: anterior, which innervates the adductor longus, adductor brevis and gracilis muscles, and posterior, which innervates the medial part of the knee joint and the posteromedial part of the thigh. It provides sensitivity to the medial aspect of the thigh.

Inclusion Criteria:

• Adult male or female
• Patient with signed consent to participate in the study,
• Patient with uni or bilateral primary gonarthrosis
• Indication for total knee arthroplasty.

Exclusion Criteria:

• History of knee fracture, arthroplasty or osteotomy
• Known or unknown contraindication to ALR or locoregional anesthesia products
• Neurological disease, stroke sequelae
• Mental deficiency or any other reason that may hinder understanding or strict application of the protocol
• Patient not affiliated to the French social security system
• Patient under court protection, guardianship or curatorship
• Pregnant or potentially pregnant women (women of childbearing age without effective contraception)
• Patient already included in another therapeutic study protocol