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Analgesia after Total Knee Arthroplasty: Peri-Articular Injection vs. Epidural + Femoral Nerve Blockade

IRB Number: 2012-056

March 17, 2010

Institutional Review Board, Hospital for Special Surgery

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Principal Investigator

Jacques T. Ya Deau, MD, PhD


Enrique A. Goytizolo, MD
Richard L. Kahn, MD
Kethy M. Jules-Elysee, MD
Devan D. Bhagat, MD
Daniel B. Maalouf, MD
Edwin P. Su, MD
David J. Mayman, MD
Geoffrey H. Westrich, MD
Douglas E. Padgett, MD
Michael M. Alexiades,MD
Amar S. Ranawat, MD
Chitranjan S. Ranawat, MD
Friedrich Boettner, MD
Yi Lin, MD
Janet Cahill
Karen Juliano
Carey Ford
Amanda Goon


The best way to provide analgesia after total knee arthroplasty is hotly debated.  There are two protocols in use at HSS.  Both protocols have their proponents, but there are limited data for making an informed choice of protocols. For total knee arthroplasty at HSS, femoral nerve blockade is commonly added to epidural analgesia, as this reduces pain with physical therapy.  However, epidural analgesia can be associated with nausea, pruritus, dizziness, and orthostatic hypotension.  Femoral nerve blockade reduces pain but also causes quadriceps weakness.  These side-effects can slow physical therapy and may prolong the time until the patient is ready for discharge. Some surgeons at HSS have decided to use a different analgesic protocol, based on a peri-articular injection.  This protocol avoids epidural analgesia, systemic opioids and nerve blockade.  However, patients are given oral opioids as part of a multimodal pain therapy. We propose to compare peri-articular injection to femoral nerve blockade and epidural PCA.   We will enroll 90 total patients (45 per study arm). The enrollment period will be approximately one year and the duration of the follow-up with study patients will be six months following their procedure.

Inclusion/Exclusion Criteria

Inclusion Criteria: 
- Patients with osteoarthritis scheduled for primary bicompartmental total knee arthroplasty with a participating surgeon
- Age 18 to 80 years old
- Planned use of regional anesthesia
- Ability to follow study protocol

Exclusion Criteria:
- Patients younger than 18 years old and older than 80
- Patients intending to receive general anesthesia
- Allergy or intolerance to one of the study medications
- Patients with an ASA of IV
- Patients with insulin-dependent diabetes
- Patients with hepatic (liver) failure
- Patients with chronic renal (kidney) failure
- Chronic opioid use (taking opioids for longer than 3 months)

Contact Information

Jacques T. YaDeau, MD, PhD