Genicular Nerve Block for Total Knee Arthroplasty
Post-operative Pain
About this trial
This is an interventional supportive care trial for Post-operative Pain focused on measuring Total knee replacement
Eligibility Criteria
Inclusion Criteria:
- Subjects scheduled for primary elective total knee arthroplasty
- American Society of Anesthesiologists Physical Status I-III
- BMI 18-40 kg/m2
Exclusion Criteria:
- Inability to cooperate with protocol
- Inability to understand or speak English
- Allergy to ropivacaine, bupivacaine or other local anesthetic
- Contraindication to peripheral nerve block (e.g. local infection, neurologic deficit or disorder, previous trauma or surgery to ipsilateral knee, etc.)
- Revision knee surgery
- Chronic opioid consumption (daily morphine equivalent of >30 mg for at least four weeks prior to surgery)
- History of chronic pain
- History of psychiatric disorder
- History of diabetes mellitus
Sites / Locations
- Duke University Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Placebo Comparator
Genicular nerve block with bupivacaine
Genicular nerve block with saline
The ultrasound-guided genicular nerve block will be performed at the site of the superior lateral, the superior medial, and the inferior medial genicular nerves. Color Doppler will be used to identify the arterial structures which serve as landmarks for the corresponding nerves. After skin local anesthetic infiltration, a 10 cm 21G insulated block needle will be inserted and aligned with the ultrasound scanning plane. Once satisfactory position of the needle is confirmed, 5mL of a solution containing 15 ml 0.25% bupivacaine with 2mg dexamethasone or 5mL saline will be slowly injected. Spread of local anesthetic will be documented adjacent to the target nerve. This procedure will be performed at the site of the three genicular nerves described.
The ultrasound-guided genicular nerve block will be performed at the site of the superior lateral, the superior medial, and the inferior medial genicular nerves. Color Doppler will be used to identify the arterial structures which serve as landmarks for the corresponding nerves. After skin local anesthetic infiltration, a 10 cm 21G insulated block needle will be inserted and aligned with the ultrasound scanning plane (in-plane approach). Once satisfactory position of the needle time is confirmed, 5mL of a saline will be slowly injected. Spread of local anesthetic will be documented adjacent to the target nerve. This procedure will be performed at the site of the three genicular nerves described.