Genicular Nerve Blocks for Anterior Cruciate Ligament Knee Surgery

Hospital for Special Surgery (HSS)

Status and phase: Completed; Phase 4

Conditions: ACL; Anterior Cruciate Ligament Injuries

Treatments: Drug: Genicular Nerve Block with bupivacaine and preservative free dexamethasone

Study type: Interventional

Funder types: Other

Identifiers

NCT05720949

2022-1962

Details and patient eligibility

About

The purpose of this randomized controlled trial is to assess a new analgesia regimen that includes the addition of genicular never blocks to our current standard regimen of peripheral nerve blocks, which includes an adductor canal block (ACB) and interspace between the popliteal artery and capsule of the posterior knee block (IPACK). The main questions it aims to answer are:

1. Does addition of genicular nerve blocks to standard peripheral block regimen significantly reduce the mean opioid consumption by 33% in the first 24 hours?
2. Does genicular nerve blocks reduce NRS pain scores?
3. Does genicular nerve blocks facilitate earlier discharge?
4. Does genicular nerve blocks last longer than 24 hours?
5. Does genicular nerve blocks improve pain management?

Eligible patients are those undergoing an anterior cruciate ligament repair at the Hospital for Special Surgery and participants will be randomized to receive the intervention (genicular nerve block) or the standard of care.

Full description

Genicular nerve blocks have been shown to provide effective analgesia for chronic osteoarthritis knee pain. There are several publications supporting its use for chronic knee pain but there is a scarcity of literature in its use in the perioperative period. Recently, it has been shown to provide effective analgesia for total knee arthroplasty. This will be a novel application for it to be used for anterior cruciate ligament surgery. There are only a couple of prospective and retrospective studies that showed promising analgesic benefits for anterior cruciate ligament repairs. There are currently no randomized controlled trials published investigating the use of genicular nerve blocks for anterior cruciate ligament surgery.

Researching novel innovative motor-sparing and opioid-sparing peripheral nerve blocks for have been the focus of research. Studies have investigated the motor sparing benefits of the adductor canal block, the effective analgesic benefits of the IPACK block, the phrenic sparing benefits of the superior trunk block, and the analgesic benefits of the pericapsular nerve group block and lateral femoral cutaneous nerve. Genicular nerve blocks would be a potential additive block that may further enhance the recovery of patients undergoing knee surgeries, including unicondylar, total knee and anterior cruciate ligament repair patients.

Enrollment: 192 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 - 80
• English speaking
• American Society of Anesthesiologists (ASA) I - III
• BMI < 35
• Scheduled for ambulatory arthroscopic unilateral anterior cruciate ligament repair surgery with bone tendon bone autograft

Exclusion criteria

• History of chronic pain syndromes
• Chronic opioid use (daily morphine milligram equivalents > 30 mg for at least 3 months)
• Contraindication to peripheral nerve blocks
• Contraindication to neuraxial anesthesia
• History of peripheral neuropathy or pre-existing neurological deficits
• Psychiatric or cognitive disorder that prohibit patient from following study protocol
• Allergy to local anesthetic or study medications
• Multi-ligament surgery
• History of substance abuse
• Infection at the site of injection

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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192 participants in 2 patient groups

Group 1 - Control

No Intervention group

Description:

Patients randomized to this group will receive an adductor canal block (ACB) and Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) nerve block.

Group 2 - Intervention

Experimental group

Description:

Patients randomized to this group will receive an adductor canal block (ACB), Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) nerve block, and the genicular nerve block (intervention). The genicular nerve block is a total of 20cc of 0.25% bupivacaine with 2mg of preservative free dexamethasone applied to the superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve, and nerve to vastus intermedius.

Treatment:

Drug: Genicular Nerve Block with bupivacaine and preservative free dexamethasone