Infiltration or Nerve Blocks in Addition to Adductor Canal Block (INCA)

GCS Ramsay Santé pour l'Enseignement et la Recherche

Status: Not yet enrolling

Conditions: Gonarthrosis; Total Knee Arthroplasty

Treatments: Procedure: Analgesia

Study type: Interventional

Funder types: Other

Identifiers

NCT06920186

COS-RGDS-2024-06-006-P-ELMALEH

2024-A02496-41 (Other Identifier)

Details and patient eligibility

About

The aim of this study is to evaluate the analgesic efficacy of this quadruple sensory block compared with the currently recommended procedure (adductor canal block + infiltration).

Full description

In addition to the adductor canal block, this quadruple block incorporates :

1. the block of the lateral cutaneous nerve of the thigh (or femoral-cutaneous nerve), which is a collateral sensory branch of the posterior part of the lumbar plexus.
2. IPACK (Infiltration between Popliteal Artery and Capsule of Knee), designed as a motor-sparing technique (targeting the sensory articular branches of the sciatic nerve and avoiding the motor branches of the tibial and fibular nerves), is particularly effective on posterior pain.
3. obturator nerve block, a mixed nerve originating from the anterior part of the lumbar plexus. It divides into two branches: anterior, which innervates the adductor longus, adductor brevis and gracilis muscles, and posterior, which innervates the medial part of the knee joint and the posteromedial part of the thigh. It provides sensitivity to the medial aspect of the thigh.

Enrollment: 100 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult male or female
• Patient with signed consent to participate in the study,
• Patient with uni or bilateral primary gonarthrosis
• Indication for total knee arthroplasty.

Exclusion criteria

• History of knee fracture, arthroplasty or osteotomy
• Known or unknown contraindication to ALR or locoregional anesthesia products
• Neurological disease, stroke sequelae
• Mental deficiency or any other reason that may hinder understanding or strict application of the protocol
• Patient not affiliated to the French social security system
• Patient under court protection, guardianship or curatorship
• Pregnant or potentially pregnant women (women of childbearing age without effective contraception)
• Patient already included in another therapeutic study protocol

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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100 participants in 2 patient groups

Group 1 of local analgesia protocol (PROSPECT recommandations)

Sham Comparator group

Description:

Locoregional analgesia (LRA) protocol n°1 : adductor canal block + surgical infiltration (PROSPECT recommendations)

Treatment:

Procedure: Analgesia

Procedure: Analgesia

Group 2 of local analgesia protocol (quadri-peripheral nerve block )

Experimental group

Description:

Locoregional analgesia (LRA) protocol n° 2 : adductor canal block + femoral-cutaneous block + obturator block + IPACK block

Treatment:

Procedure: Analgesia

Procedure: Analgesia