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

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

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Total Knee Arthroplasty
• Intervention / Treatment: Procedure: Surgical local infiltration; Procedure: Obturator nerve block; Procedure: Femoral nerve block; Procedure: Sciatic nerve block; Procedure: Lateral femoral cutaneous nerve block

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Philippe MARTY, MD; Phone Number: 33 05 62 13 29 97; Email: philippemarty@hotmail.com

Study Locations

• France
  • Haute-Garonne
    • Toulouse, Haute-Garonne, France, 31036
      • Clinique MEDIPOLE GARONNE
      • Contact: Clément CHASSERY, MD; Phone Number: 33 05 62 13 29 97; Email: cchassery@gmail.com
      • Principal Investigator: Clément CHASSERY, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: LIA group; Local infiltration analgesia	Procedure: Surgical local infiltration; 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
Experimental: Quadruple nerve blocks group; Femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks	Procedure: Obturator nerve block; Injection of 20 mL of 0.1% ropivacaine between the adductor magnus and adductor brevis muscles and between the adductor brevis and pectineus muscles; Procedure: Femoral nerve block; Injection of 15 mL of 0.1% ropivacaine under the fascia iliaca, with the patient in supine position; Procedure: Sciatic nerve block; Injection of 20 mL of 0.1% ropivacaine in the subgluteal space via a lateral approach, with the patient in prone position; Procedure: Lateral femoral cutaneous nerve block; Injection of 5 mL of 0.1% ropivacaine lateral to the sartorius muscle

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total opioid consumption within 24 hours	Total cumulative opioid consumption during the first 24 hours, expressed in oral morphine equivalents (OME, mg), including intraoperative and postoperative opioid administration.	From start of surgery (t0) to 24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraoperative anesthetic consumption	Total intraoperative consumption of propofol (mg)	During surgery
Intraoperative opioid consumption	Total intraoperative consumption of sufentanil (µg)	During surgery
Intraoperative hypertension events	Occurrence of intraoperative hypertension episodes defined as systolic blood pressure >160 mmHg	During surgery
Intraoperative hypotension events	Occurrence of intraoperative hypotension episodes defined as systolic blood pressure <90 mmHg	During surgery
Postoperative pain intensity	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	Up to 48 hours postoperatively
Total opioid consumption within 48 hours	Total cumulative opioid consumption during the first 48 hours, expressed in oral morphine equivalents (OME, mg), including intraoperative and postoperative opioid administration.	From start of surgery (t0) to 48 hours postoperatively
Opioid-related adverse effects	Incidence of nausea and vomiting, somnolence, constipation, acute urinary retention, pruritus, and disorientation.	Up to 48 hours postoperatively
Quadricep motor function	Quadriceps muscle strength assessed on a 3-point scale: 0 = paralysis; 1 = paresis; 2 = normal contraction	Postoperative days 0, 1, and 2
Foot elevator muscle motor function	Ankle dorsiflexor muscle strength assessed on a 3-point scale: 0 = paralysis; 1 = paresis; 2 = normal contraction	Postoperative days 0, 1, and 2
Ability to stand and walk	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	Postoperative days 0, 1, and 2
Mobility and balance	Timed Up and Go (TUG) test, measured in seconds	Postoperative days 0, 1, and 2
Functional Independence	Functional Independence Measure (FIM), with total scores ranging from 18 to 126, where higher scores indicating greater independence	Postoperative days 0, 1, and 2
Postoperative falls	Occurrence of any fall defined as an unintentional event resulting in the patient coming to rest on the ground or a lower level	Postoperative days 0, 1, and 2
Hospital readmission within 30 days	Any hospital readmission within 30 days after surgery, regardless of cause	30 days postoperatively
Functional outcome at 60 days	Short-form WOMAC index focused on physical function), with total scores ranging from 0 to 28, where higher scores indicating greater functional impairment	60 days postoperatively

Collaborators and Investigators

• Sponsor: CMC Ambroise Paré

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): December 2, 2027
• Study Completion (Estimated): February 1, 2028

Study Registration Dates

• First Submitted: March 13, 2026
• First Submitted That Met QC Criteria: March 13, 2026
• First Posted (Actual): March 17, 2026

Study Record Updates

• Last Update Posted (Actual): March 17, 2026
• Last Update Submitted That Met QC Criteria: March 13, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Pain management; Ropivacaine; Knee arthroplasty; Opioids; Postoperative analgesia; Regional anesthesia; Local Infiltration Analgesia
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Agnosia
• Other Study ID Numbers: 2025/02

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No