Genicular Nerve Blocks for Anterior Cruciate Ligament Knee Surgery

January 7, 2026 updated by: Hospital for Special Surgery, New York

Genicular Nerve Blocks for Arthroscopic Anterior Cruciate Knee Surgery: a Randomized Controlled Trial

The purpose of this randomized controlled trial is to assess a new analgesia regimen that includes the addition of genicular never blocks to our current standard regimen of peripheral nerve blocks, which includes an adductor canal block (ACB) and interspace between the popliteal artery and capsule of the posterior knee block (IPACK). The main questions it aims to answer are:

  1. Does addition of genicular nerve blocks to standard peripheral block regimen significantly reduce the mean opioid consumption by 33% in the first 24 hours?
  2. Does genicular nerve blocks reduce NRS pain scores?
  3. Does genicular nerve blocks facilitate earlier discharge?
  4. Does genicular nerve blocks last longer than 24 hours?
  5. Does genicular nerve blocks improve pain management?

Eligible patients are those undergoing an anterior cruciate ligament repair at the Hospital for Special Surgery and participants will be randomized to receive the intervention (genicular nerve block) or the standard of care.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Genicular nerve blocks have been shown to provide effective analgesia for chronic osteoarthritis knee pain. There are several publications supporting its use for chronic knee pain but there is a scarcity of literature in its use in the perioperative period. Recently, it has been shown to provide effective analgesia for total knee arthroplasty. This will be a novel application for it to be used for anterior cruciate ligament surgery. There are only a couple of prospective and retrospective studies that showed promising analgesic benefits for anterior cruciate ligament repairs. There are currently no randomized controlled trials published investigating the use of genicular nerve blocks for anterior cruciate ligament surgery.

Researching novel innovative motor-sparing and opioid-sparing peripheral nerve blocks for have been the focus of research. Studies have investigated the motor sparing benefits of the adductor canal block, the effective analgesic benefits of the IPACK block, the phrenic sparing benefits of the superior trunk block, and the analgesic benefits of the pericapsular nerve group block and lateral femoral cutaneous nerve. Genicular nerve blocks would be a potential additive block that may further enhance the recovery of patients undergoing knee surgeries, including unicondylar, total knee and anterior cruciate ligament repair patients.

Study Type

Interventional

Enrollment (Actual)

192

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • New York
      • New York, New York, United States, 10019
        • HSS Sports Medicine Institute West Side

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 18 - 80
  • English speaking
  • American Society of Anesthesiologists (ASA) I - III
  • BMI < 35
  • Scheduled for ambulatory arthroscopic unilateral anterior cruciate ligament repair surgery with bone tendon bone autograft

Exclusion Criteria:

  • History of chronic pain syndromes
  • Chronic opioid use (daily morphine milligram equivalents > 30 mg for at least 3 months)
  • Contraindication to peripheral nerve blocks
  • Contraindication to neuraxial anesthesia
  • History of peripheral neuropathy or pre-existing neurological deficits
  • Psychiatric or cognitive disorder that prohibit patient from following study protocol
  • Allergy to local anesthetic or study medications
  • Multi-ligament surgery
  • History of substance abuse
  • Infection at the site of injection
  • diagnoses of Type I or Type II diabetes

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Group 1 - Control
Patients randomized to this group will receive an adductor canal block (ACB) and Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) nerve block.
Experimental: Group 2 - Intervention

Patients randomized to this group will receive an adductor canal block (ACB), Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) nerve block, and the genicular nerve block (intervention).

The genicular nerve block is a total of 20cc of 0.25% bupivacaine with 2mg of preservative free dexamethasone applied to the superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve, and nerve to vastus intermedius.
Drug: Genicular Nerve Block with bupivacaine and preservative free dexamethasone

A genicular nerve block is a peripheral nerve block that temporarily anesthetizes the sensory terminal branches innervating the knee joint by injecting local anesthesia. This results in anesthesia of the anterior compartment of the knee.

The genicular nerve block consists of 20cc of 0.25% bupivacaine with 2mg of preservative free dexamethasone and will be applied to the superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve, and nerve to vastus intermedius.

Bupivacaine - Drug class: Sodium channel blocker

Dexamethasone - Drug class: Glucocorticoid

Other Names:
  • Exparel
  • Ozurdex

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mean Opioid Consumption at 24 Hours
Time Frame: Post-operative care unit (PACU) arrival time to 24 hours

Intravenous and Oral opioid consumption at 24 hours after recovery room entry will be recorded.

The average consumption will be reported in morphine milligram equivalents.
Post-operative care unit (PACU) arrival time to 24 hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Opioid Consumption
Time Frame: PACU(PACU arrival time to removal from board), 48,72,96,168 hours after time zero (PACU arrival time)

Opioid consumption up to 168 hours after surgery will be recorded from the medical record and patient reported phone calls

Opioid consumption in morphine milligram equivalents will be calculated and reported for each time point.
PACU(PACU arrival time to removal from board), 48,72,96,168 hours after time zero (PACU arrival time)
Numeric Rating Scale (NRS) Pain Scores
Time Frame: PACU (60 minutes after PACU arrival time), 24,48,72,96,168 hours after time zero (PACU arrival time)
Patient scores at rest and with movement will be recorded. Scale of 0 to 10, with 0 meaning "no pain" and 10 meaning "worst pain imaginable". Lower score means less pain, higher score means greater pain.
PACU (60 minutes after PACU arrival time), 24,48,72,96,168 hours after time zero (PACU arrival time)
Cumulative Opioid Consumption
Time Frame: sum of opioid used from 0-24 hours, 0-48 hours, and 0-72 hours, 0-96 hours post-operatively
Total opioid consumption will be recorded up to 96 hours after surgery.
sum of opioid used from 0-24 hours, 0-48 hours, and 0-72 hours, 0-96 hours post-operatively
Brief Pain Inventory
Time Frame: Pre-operatively, 24 hours, 48 hours, 72 hours, 96 hours, 168 hours post-operative

This questionnaire will assess severity of pain, impact of pain on daily function, location of pain, medication intake, and amount of pain relief preoperatively and at 24 hours, 48 hours, 72 hours, 96 hours, and 168 hours after surgery.

Questions are rated on a scale of 0 to 10, with 0 meaning "no pain/interference" and 10 meaning "pain as bad as you can imagine/completely interferes".
Pre-operatively, 24 hours, 48 hours, 72 hours, 96 hours, 168 hours post-operative
Patient Satisfaction With Pain Treatment
Time Frame: From the time patient arrived in the post-operative care unit (PACU), at 24 hours, and at 48 hours post-operative

Patient satisfaction will be assessed in the post-operative care unit (PACU), 24 hours, and 48 hours after surgery.

Patients reported satisfaction for 3 subcategories: 1) Satisfaction with Pain Management, 2) Satisfaction with Being Informed and Involved with Decision Making, 3) Satisfaction with Care from Healthcare Team. Each subcategory had a scale of 0-10, with 0 being strongly dissatisfied and 10 being strongly satisfied.
From the time patient arrived in the post-operative care unit (PACU), at 24 hours, and at 48 hours post-operative
Duration of Analgesic Block
Time Frame: 24 hours and 48 hours post-operative
To assess when the patient believe the analgesic block wore off and they regain sensation in their leg.
24 hours and 48 hours post-operative
Success of Adductor Canal Block
Time Frame: Post-operative care unit (PACU)
Numbness in the saphenous distribution will be assessed in the PACU by an anesthesiologist or research assistant. This was measured on scale of 0-2, with 0 being no sensation, 1 being partial sensation, and 2 being full sensation.
Post-operative care unit (PACU)
Readiness for PACU Discharge
Time Frame: From the time the patient arrived in the post-operative care unit (PACU) arrival time to the time the patient is discharged(discharge ready time = recovery complete time) assessed up to 24 hours after surgery.

The duration from PACU arrival time to recovery complete time.

The time that it took for the patient to be discharged will be calculated and reported.
From the time the patient arrived in the post-operative care unit (PACU) arrival time to the time the patient is discharged(discharge ready time = recovery complete time) assessed up to 24 hours after surgery.
Length of PACU Stay
Time Frame: From the time the patient arrived in the post-operative care unit (PACU) arrival time to the time they leave the PACU assessed up to 24 hours after surgery.

The duration from PACU arrival time to patient removed from board time.

The time (in minutes) will be calculated and reported.
From the time the patient arrived in the post-operative care unit (PACU) arrival time to the time they leave the PACU assessed up to 24 hours after surgery.
Adverse Events
Time Frame: Post-operative care unit (PACU) arrival time up to 72 hours after the surgery

Incidence of neuropraxia (neurological symptoms over 3 days), local anesthetic systemic toxicity (LAST), and infection.

The number of adverse events will be reported.
Post-operative care unit (PACU) arrival time up to 72 hours after the surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hospital for Special Surgery, New York

Investigators

  • Principal Investigator: David H Kim, MD, Hospital for Special Surgery, Department of Anesthesiology
  • Study Director: Jashvant Poeran, MD/PhD, Hospital for Special Surgery, Department of Anesthesiology

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 12, 2023

Primary Completion (Actual)

November 26, 2024

Study Completion (Actual)

December 2, 2024

Study Registration Dates

First Submitted

January 18, 2023

First Submitted That Met QC Criteria

February 6, 2023

First Posted (Actual)

February 9, 2023

Study Record Updates

Last Update Posted (Actual)

January 26, 2026

Last Update Submitted That Met QC Criteria

January 7, 2026

Last Verified

December 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2022-1962

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

There is no plan to share individual patient data with other researchers.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

Yes

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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