December 09, 2010
Institutional Review Board, Hospital for Special Surgery
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Our study will compare the use of saphenous nerve blocks performed at the adductor canal versus femoral nerve blocks for total knee replacements. We hypothesize that the saphenous nerve block performed at the level of the adductor canal provides adequate pain relief without significantly compromising muscle strength, enabling patients to mobilize early and possibly be discharged earlier to the rehabilitation center.
We will enroll a total of 84 patients (42 patients will receive the saphenous nerve block and 42 will receive the femoral nerve block). Before and after surgery, we will assess motor strength of the operative and nonoperative legs by a neurologic exam (based on a 12 point scale) and by using a hand held dynamometer. Until discharge, we will also record patients’ pain scores, physical therapy progress and satisfaction.
If our study proves the saphenous nerve block to be an effective method of postoperative pain control without compromising quadriceps strength, it would be seen as a better alternative to femoral nerve blocks.
Inclusion Criteria
All patients ages 18-90 undergoing primary unilateral total knee arthroplasty
· Planned use of neuraxial anesthesia
· Ability to follow study protocol
· American Society of Anesthesiology (ASA) Class 1-3
Exclusion Criteria
· Contraindication to a spinal or epidural anesthetic
· Chronic opioid use (defined as daily or almost daily use of opioids for >3 months)
· Hypersensitivity and/or allergy to local anesthetics
· Intraoperative use of any volatile anesthetic
· Patients with a pre-existing neuropathy on the operative limb
· Contraindication to a femoral nerve block or saphenous nerve block
· Allergy to any of the study medications
· ASA Class 4-5
· Non-English speaking patients
David Kim, MD
kimd@hss.edu
212.606.1206