Postoperative Analgesia in Knee Replacement Surgery Comparing Local Infiltration Analgesia Alone With Ultrasound-guided Nerve Blocks Added, a Randomized Clinical Trial

What this Trial Is About

Researchers are evaluating pain management techniques in people undergoing total knee replacement surgery due to osteoarthritis. The study compares local infiltration analgesia (LIA) alone with a combination of LIA plus three sensory nerve blocks: the saphenous nerve (SN) block, nerve to vastus medialis (NVM) block, and anterior femoral cutaneous nerve (AFCN) block. This randomized clinical trial aims to find out if adding these nerve blocks improves pain control, reduces opioid use, and helps early mobilization without affecting muscle function. Participants are randomly assigned to one of two groups. One group receives ultrasound-guided nerve blocks to the NVM, SN, and AFCN nerves before surgery along with LIA administered by the surgeon during the operation. The other group receives only the LIA during surgery without nerve blocks. The nerve blocks involve specific doses of ropivacaine with clonidine injected near the nerves under ultrasound guidance, while the LIA involves ropivacaine with adrenaline injected around the knee joint and surrounding tissues. Both groups receive standard pain medications before surgery. During the study, participants will be assessed for pain intensity using a numerical rating scale at several time points up to 14 days after surgery. Researchers will also track opioid use, time to start moving after surgery, nausea and vomiting, neurological side effects, and hospital stay length. Neurological complications will be followed for up to six months if they occur. Anesthesia type, either general or spinal, is chosen based on clinical need and independently of group assignment. The study will last from preoperative randomization until follow-up assessments after surgery.

Combination of Nerve Blocks and Local Infiltration Analgesia in Knee Arthroplasty