Analgesic Benefits of Genicular Nerve Blocks of the Posterior Knee for Patients Undergoing Anterior Cruciate Ligament (ACL) Reconstruction
| Status: | Active, not recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 70 |
| Updated: | 4/21/2016 |
| Start Date: | December 2013 |
Outpatients scheduled to have ACL surgery typically receive a femoral nerve block to provide
analgesia for the front of the knee. Postoperatively, these patients will often report pain
in the back of the knee. Local anesthetic infiltration of the posterior aspect of the knee
results in blockade of the genicular nerves of the posterior knee. These nerves originate
off of the tibial and common peroneal nerves and their blockade will result in improved
posterior knee pain relief and may decrease narcotic consumption compared to patients who
receive the same infiltration with normal saline.
analgesia for the front of the knee. Postoperatively, these patients will often report pain
in the back of the knee. Local anesthetic infiltration of the posterior aspect of the knee
results in blockade of the genicular nerves of the posterior knee. These nerves originate
off of the tibial and common peroneal nerves and their blockade will result in improved
posterior knee pain relief and may decrease narcotic consumption compared to patients who
receive the same infiltration with normal saline.
Femoral nerve blocks are commonly used to provide postoperative analgesia for ACL surgery.
The limitation of these blocks is the incomplete analgesia they provide of the knee joint
subjecting the patient to posterior knee pain. As a result, some of these patients receive
rescue sciatic blocks in the postoperative care unit to cover posterior knee pain. The
sciatic block provides excellent analgesia for the posterior knee; however its blockade
invariably affects other territories of the sciatic nerve such as the lower leg and foot.
For ACL surgery, the loss of sensation and/or motor strength to this area is unnecessary and
may make ambulation more difficult. The ability to ambulate with minimal assistance may be
more important for a patient undergoing an outpatient surgery when compared to an inpatient
surgery.
At the posterior knee, the sciatic nerve branches off into the tibial and common peroneal
nerves which give rise to sensory fibers that innervate the posterior knee. We propose
targeting these terminal fibers in the popliteal fossa by infiltrating local anesthetic
between the distal femoral shaft and popliteal artery thereby providing posterior knee
analgesia without affecting the lower leg.This application of this block has not been
studied in patients having ACL surgery. A single interim analysis is scheduled after the
data for 50 cases are available.
The limitation of these blocks is the incomplete analgesia they provide of the knee joint
subjecting the patient to posterior knee pain. As a result, some of these patients receive
rescue sciatic blocks in the postoperative care unit to cover posterior knee pain. The
sciatic block provides excellent analgesia for the posterior knee; however its blockade
invariably affects other territories of the sciatic nerve such as the lower leg and foot.
For ACL surgery, the loss of sensation and/or motor strength to this area is unnecessary and
may make ambulation more difficult. The ability to ambulate with minimal assistance may be
more important for a patient undergoing an outpatient surgery when compared to an inpatient
surgery.
At the posterior knee, the sciatic nerve branches off into the tibial and common peroneal
nerves which give rise to sensory fibers that innervate the posterior knee. We propose
targeting these terminal fibers in the popliteal fossa by infiltrating local anesthetic
between the distal femoral shaft and popliteal artery thereby providing posterior knee
analgesia without affecting the lower leg.This application of this block has not been
studied in patients having ACL surgery. A single interim analysis is scheduled after the
data for 50 cases are available.
Inclusion Criteria:
1. patients who are presenting for ACL reconstruction
2. candidates for peripheral nerve blocks patients
3. ASA 1-3
Exclusion Criteria:
1. Patient refusal
2. ASA Classification of 4 or higher
3. Pre-existing neuropathy in the femoral or sciatic distribution
4. Coagulopathy
5. Infection at the site
6. Non-English speaking or non-reading patients
7. Chronic opioid use (>3months)
8. Pregnancy
9. Any other contra-indication to regional anesthesia
10. Failed femoral nerve block
11. Sciatic nerve block placed due to severe pain not managed by intravenous and oral
agents.
We found this trial at
1
site
303 E Chicago Ave
Chicago, Illinois 60611
Chicago, Illinois 60611
(312) 503-8194
Northwestern University Feinberg School of Medicine Northwestern University Feinberg School of Medicine, founded in 1859,...
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