Evaluation of the Analgesic Benefit of Adding the Blocks of the Intermediate and Medial Femoral Cutaneous Nerves in Addition to the Femoral Triangle Block for Postoperative Analgesia After a Knee Replacement Surgery

Despite many advances, the postoperative analgesia offered by the present techniques remains imperfect, the femoral triangle block does not make it possible to completely cover the cutaneous component of the classic midline incision used for a total knee arthroplasty. This incision would fall more under the anterior cutaneous femoral nerves, more specifically the intermediate and medial cutaneous femoral nerves. A recently described approach offers the prospect of better covering this skin incision, by specifically blocking these nerves using the same needle path as for the femoral triangle block. Although the feasibility of this approach has been studied in healthy volunteers and in a few clinical cases, no randomized controlled study has been conducted to determine whether the addition of cutaneous femoral nerve blocks offers an analgesic benefit in the population undergoing total knee replacement surgery. This is therefore necessary in order to assess whether this approach improves the clinical trajectory of patients receiving a total knee arthroplasty.

Inclusion criteria

• 18 years and over, requiring a primary total knee arthroplasty
• 'American Society of Anesthesiologists' classification 1 to 3

Exclusion criteria

• Refusal or unable to consent
• Contraindications to a peripheral nerve block;
• Inability to communicate with the healthcare team or the research team;
• Inability to understand follow-up instructions or questionnaires;
• Chronic pain requiring the intake of the equivalent of more than 60 mg of morphine daily;
• Pregnancy;
• Patients weighing less than 50 kg (to limit the risk of intoxication with local anesthetics).