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NCT Number: NCT07477730

Local Infiltration Analgesia Versus Quadruple Nerve Blocks in Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is one of the most common orthopedic surgical procedures and is associated with severe pain in the immediate postoperative period, thus limiting early recovery.

Optimal postoperative pain management after TKA is not fully defined. While multimodal analgesia is standard, the choice of associated regional anesthesia techniques is debated.

Local infiltration analgesia (LIA) is widely used and provides effective pain relief without impairing early mobilization.

Peripheral nerve blocks have been discussed due to the risk of motor blockade, but low-concentration local anesthetics, such as 0.1% ropivacaine, allow sensory blockade while preserving motor function. Preliminary studies suggest that this concentration is effective and safe.

The main objective of this monocenter, prospective, randomized, open-label, controlled trial is to compare the analgesic efficacy of a quadruple nerve blocks (femoral, sciatic, obturator, and lateral femoral cutaneous nerves) using 0.1% ropivacaine versus standard LIA in patients undergoing TKA.

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Key information

Conditions

Total Knee Arthroplasty Agnosia Nervous System Diseases Neurobehavioral Manifestations Neurologic Manifestations Pathological Conditions, Signs and Symptoms Perceptual Disorders Signs and Symptoms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Clinique Médipôle Garonne

Toulouse, Haute-Garonne, 31036, France

Location contact

Clément CHASSERY, MD

CONTACT

[email protected]

05 62 13 29 97 ext. 33

Clément CHASSERY, MD

PRINCIPAL_INVESTIGATOR

About this study

In the pre-anaesthesia room, after the implementation of classical monitoring with an oxygen mask and a peripheral venous catheter, all patients will receive an antibioprophylaxis according to the recommendations of the SFAR (French Society of Anesthesia & Intensive Care Medecine) and an injection of 10 mg of IV dexamethasone.

The surgical procedure is a total knee arthroplasty (TKA) performed under general anesthesia (GA) with a laryngeal mask. The only difference between the two groups will be the site and technique of local anesthetic (LA) injection.

The patients will be randomized into two groups:

  • LIA group (usual technique): surgical local infiltration
  • Quadruple nerve blocks group (experimental technique): femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks

In the operating room, general anesthesia will be induced with intravenous ketamine (0.4 mg/kg) and propofol (3 mg/kg). Anesthesia will be maintained with propofol.

Other medications administered intraoperatively:

  • Tranexamic acid (1 g)
  • Uradipil (5 mg every 3 minutes) if systolic blood pressure (SBP) > 160 mmHg
  • Norepinephrine (10 µg every 3 minutes) or Ephedrine (6 mg every 3 minutes) if SBP < 90 mmHg
  • Sufentanil (initial dose of 5 µg, then 5 µg every 5 minutes as needed at the anesthesiologist's discretion)

Postoperative analgesia protocol:

  • Multimodal analgesia will be instituted from the end of the surgery by the administration of paracetamol (1 g) and ketoprofen (100 mg).
  • In post-anesthesia care unit (PACU): oxycodone titration if VRS (pain score) >3 according to the centre's usual care.
  • In ward: systematic per os analgesia with paracetamol (1 g, 4 times a day) and ibuprofen (400 mg, 3 times a day), oxycodone (10 mg, lockout interval: 4 h) if VRS (pain score) >3 and cryotherapy.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients undergoing primary total knee arthroplasty under general anesthesia (laryngeal mask airway)
  • Fully autonomous at home
  • Planned discharge to home
  • Consent for participation
  • Affiliation to a social security system

Exclusion criteria

  • Preoperative opioid use
  • Chronic pain syndrome
  • Valgus contraindicating sciatic nerve block
  • Contraindication to any drugs used in the protocol
  • Contraindication to laryngeal mask airway
  • Pregnant or breastfeeding women
  • Patients under protection of the adults (guardianship, curators or safeguard of justice)

Treatment and study plan

Surgical local infiltration

Procedure

Injection of 150 mL of ropivacaine 0.2% into periarticular tissues according to a standardized sequence, including the posterior capsule, collateral ligaments, quadriceps, patellar tendon, capsule and subcutaneous tissue before wound closure

Obturator nerve block

Procedure

Injection of 20 mL of 0.1% ropivacaine between the adductor magnus and adductor brevis muscles and between the adductor brevis and pectineus muscles

Femoral Nerve Block

Procedure

Injection of 15 mL of 0.1% ropivacaine under the fascia iliaca, with the patient in supine position

Sciatic Nerve Block

Procedure

Injection of 20 mL of 0.1% ropivacaine in the subgluteal space via a lateral approach, with the patient in prone position

Lateral femoral cutaneous nerve block

Procedure

Injection of 5 mL of 0.1% ropivacaine lateral to the sartorius muscle

Primary outcomes

  1. Total opioid consumption within 24 hours

    Time frame: From start of surgery (t0) to 24 hours postoperatively

    Total cumulative opioid consumption during the first 24 hours, expressed in oral morphine equivalents (OME, mg), including intraoperative and postoperative opioid administration.

Secondary outcomes

  1. Intraoperative anesthetic consumption

    Time frame: During surgery

    Total intraoperative consumption of propofol (mg)

  2. Intraoperative opioid consumption

    Time frame: During surgery

    Total intraoperative consumption of sufentanil (µg)

  3. Intraoperative hypertension events

    Time frame: During surgery

    Occurrence of intraoperative hypertension episodes defined as systolic blood pressure >160 mmHg

  4. Intraoperative hypotension events

    Time frame: During surgery

    Occurrence of intraoperative hypotension episodes defined as systolic blood pressure <90 mmHg

  5. Postoperative pain intensity

    Time frame: Up to 48 hours postoperatively

    Pain intensity at rest assessed using a verbal rating scale (VRS, 0-10) ranging from 0 to 10 (0=no pain, 10=worst possible pain), recorded every 6 hours during the first 48 postoperative hours

  6. Total opioid consumption within 48 hours

    Time frame: From start of surgery (t0) to 48 hours postoperatively

    Total cumulative opioid consumption during the first 48 hours, expressed in oral morphine equivalents (OME, mg), including intraoperative and postoperative opioid administration.

  7. Opioid-related adverse effects

    Time frame: Up to 48 hours postoperatively

    Incidence of nausea and vomiting, somnolence, constipation, acute urinary retention, pruritus, and disorientation.

  8. Quadricep motor function

    Time frame: Postoperative days 0, 1, and 2

    Quadriceps muscle strength assessed on a 3-point scale: 0 = paralysis; 1 = paresis; 2 = normal contraction

  9. Foot elevator muscle motor function

    Time frame: Postoperative days 0, 1, and 2

    Ankle dorsiflexor muscle strength assessed on a 3-point scale: 0 = paralysis; 1 = paresis; 2 = normal contraction

  10. Ability to stand and walk

    Time frame: Postoperative days 0, 1, and 2

    4-point scale: 0 = unable to get up; 1 = able to get up but unable to walk; 2 = able to walk <50 m; 3 = able to walk ≥50 m

  11. Mobility and balance

    Time frame: Postoperative days 0, 1, and 2

    Timed Up and Go (TUG) test, measured in seconds

  12. Functional Independence

    Time frame: Postoperative days 0, 1, and 2

    Functional Independence Measure (FIM), with total scores ranging from 18 to 126, where higher scores indicating greater independence

  13. Postoperative falls

    Time frame: Postoperative days 0, 1, and 2

    Occurrence of any fall defined as an unintentional event resulting in the patient coming to rest on the ground or a lower level

  14. Hospital readmission within 30 days

    Time frame: 30 days postoperatively

    Any hospital readmission within 30 days after surgery, regardless of cause

  15. Functional outcome at 60 days

    Time frame: 60 days postoperatively

    Short-form WOMAC index focused on physical function), with total scores ranging from 0 to 28, where higher scores indicating greater functional impairment

Study contacts

Contact information is provided by the study sponsor or research team.

Philippe MARTY, MD

CONTACT

[email protected]

05 62 13 29 97 ext. 33

Sponsors and collaborators

Lead sponsor

CMC Ambroise Paré

Other

Registry information

Official study title

Local Infiltration Analgesia Versus Quadruple Nerve Blocks in Total Knee Arthroplasty: a Randomized Controlled Trial.

Acronym: LIAQ

Important dates

Study start
2026
Primary completion
2027
Study completion
2028
First posted
Mar 17, 2026
Registry last updated
Mar 17, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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