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Local Infiltration Analgesia Versus Quadruple Nerve Blocks in Total Knee Arthroplasty.

Sponsor: CMC Ambroise Paré • ClinicalTrials.gov ID: NCT07477730

Registry updated: 2026-09-14

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Description

Total knee arthroplasty (TKA) is one of the most common orthopedic surgical procedures and is associated with severe pain in the immediate postoperative period, thus limiting early recovery. Optimal postoperative pain management after TKA is not fully defined. While multimodal analgesia is standard, the choice of associated regional anesthesia techniques is debated. Local infiltration analgesia (LIA) is widely used and provides effective pain relief without impairing early mobilization. Peripheral nerve blocks have been discussed due to the risk of motor blockade, but low-concentration local anesthetics, such as 0.1% ropivacaine, allow sensory blockade while preserving motor function. Preliminary studies suggest that this concentration is effective and safe. The main objective of this monocenter, prospective, randomized, open-label, controlled trial is to compare the analgesic efficacy of a quadruple nerve blocks (femoral, sciatic, obturator, and lateral femoral cutaneous nerves) using 0.1% ropivacaine versus standard LIA in patients undergoing TKA.

Interventions

Surgical local infiltration (Procedure)
Injection of 150 mL of ropivacaine 0.2% into periarticular tissues according to a standardized sequence, including the posterior capsule, collateral ligaments, quadriceps, patellar tendon, capsule and subcutaneous tissue before wound closure
Obturator nerve block (Procedure)
Injection of 20 mL of 0.1% ropivacaine between the adductor magnus and adductor brevis muscles and between the adductor brevis and pectineus muscles
Femoral nerve block (Procedure)
Injection of 15 mL of 0.1% ropivacaine under the fascia iliaca, with the patient in supine position
Sciatic nerve block (Procedure)
Injection of 20 mL of 0.1% ropivacaine in the subgluteal space via a lateral approach, with the patient in prone position
Lateral femoral cutaneous nerve block (Procedure)
Injection of 5 mL of 0.1% ropivacaine lateral to the sartorius muscle

Eligibility criteria

Inclusion Criteria: * Patients undergoing primary total knee arthroplasty under general anesthesia (laryngeal mask airway) * Fully autonomous at home * Planned discharge to home * Consent for participation * Affiliation to a social security system Exclusion Criteria: * Preoperative opioid use * Chronic pain syndrome * Valgus contraindicating sciatic nerve block * Contraindication to any drugs used in the protocol * Contraindication to laryngeal mask airway * Pregnant or breastfeeding women * Patients under protection of the adults (guardianship, curators or safeguard of justice)

Conditions

Total Knee Arthroplasty

Locations

Clinique Médipôle Garonne — Toulouse, Haute-Garonne, France

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Official Source

Data sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

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