Combined Distal Femoral Nerve Block for Pain Control After Knee Replacement

Comparative Study Assessing the Efficacy of a Combined Distal Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty (TKA)

The goal of this clinical trial is to see whether a combined distal femoral nerve block improves pain relief after total knee replacement in adults having planned surgery. The main questions it aims to answer are:

• Does the combined distal femoral nerve block reduce the amount of opioid needed in the post-anesthesia recovery room?
• Does it preserve quadriceps muscle strength while improving postoperative pain control?

Researchers will compare the combined distal femoral nerve block to a saphenous nerve block alone to see if the combined block provides better analgesia without reducing leg strength.

Participants will:

• Receive either the combined distal femoral nerve block or the saphenous nerve block alone before surgery.
• Also receive standard multimodal pain management, including anesthesia, surgical site infiltration, and postoperative pain medications.
• Be assessed for pain, opioid use, nausea and vomiting, quadriceps strength, time to first standing, hospital stay length, and patient satisfaction from surgery until discharge.

Inclusion Criteria:

• Adult patients aged over 18 years.
• Scheduled for total knee arthroplasty with multimodal analgesia.
• Affiliated with or benefiting from a social security system.
• Able to understand the study information and provide written informed consent.

Exclusion Criteria:

• Emergency surgery.
• Weight under 50 kg.
• Body mass index over 40 kg/m².
• Contraindication to nefopam, non-steroidal anti-inflammatory drugs, local anesthetics, or morphine.
• Preoperative opioid use.
• Antidepressant or gabapentinoid treatment.
• Other planned surgical or medical procedures during the study period.
• Participation in another clinical trial, or currently in an exclusion period from another trial.
• Inability to understand study information for linguistic, psychological, cognitive, or literacy reasons.
• Pregnancy, possible pregnancy without effective contraception, or breastfeeding.
• Protected adults, including those under guardianship, curatorship, legal protection, detention, or otherwise unable to give informed consent.