AzTrials
AzTrials

Joint DiseasesNCT06074744

Subsartorial Nerve Block and Femoral Nerve Block in Total Knee Arthroplasty

A study testing SSNB + IPACK and FNB + IPACK in people with Joint Diseases and Joint Pain, run by Luzerner Kantonsspital at 1 site in Switzerland.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The goal of this clinical trial is to compare two different types of nerve blocks in patients undergoing surgery for primary Total Knee Arthroplasty. The main question aim to answer is: is there a benefit in functional muscle power output of the leg? Participants will be randomized into either the intervention group… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Joint Diseases, Joint Pain
What is being tested?
SSNB + IPACK and FNB + IPACK
Could I receive a placebo?
No, everyone receives an active treatment
How many people
144 participants
Where
1 siteSwitzerland
Study dates
30 Nov 2023to Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • age > 18yrs
  • primary TKA
  • BMI 35kg/m2 or less
  • able to give informed consent as documented by signature
  • clinical history without any contraindications for the planned intervention

Who cannot join

  • age < 18 years
  • revision-TKA
  • BMI >35kg/m2
  • absent contact information
  • inability or contraindications to undergo the investigated intervention (TKA, FNB, SSNB), - clinically significant concomitant diseases
  • pregnancy
  • inability to follow the procedures and follow-up procedures of the study (e.g. due to language problems, psychological disorders, dementia, living abroad, etc.
  • withdrawal from the study

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Judith Bering, Dr. med. contact

+41 41 205 18 91

judith.bering@luks.ch

Laura V Buchmann, Dr. med. contact

0041-41-2057855

laura.buchmann@luks.ch

Switzerland1 site, 1 recruiting
  • Luzerner Kantonsspital

    Lucerne, 6000

    Judith Bering, Dr. med., +41-41-2051891, judith.bering@luks.ch

    Laura V Buchmann, Dr. med., +41-41-2057855, laura.buchmann@luks.ch

    Recruiting

Other trials in Switzerland

About this study

Official title: Subsartorial Saphenous Nerve Block (SSNB) Versus Femoral Nerve Block (FNB) in Primary Total Knee Arthroplasty (TKA) Combined With Infiltration Between Popliteal Artery and Capsule of the Knee (IPACK) - Where Are the Benefits?

The goal of this clinical trial is to compare two different types of nerve blocks in patients undergoing surgery for primary Total Knee Arthroplasty. The main question aim to answer is:

  • is there a benefit in functional muscle power output of the leg?
Read more

Participants will be randomized into either the intervention group or the control group and:

  • receive Subsartorial Saphenous Nerve Block (SSNB) + IPACK in intervention group (group 1)
  • receive Femoral Nerve Block (FNB) + IPACK in control group (group 2)

Researchers will compare the 2 groups to see if there are differences in :

  • functional muscle power output of the leg?
  • muscle function, mobility, clinical and radiological results, ROM, pain control (NRS), opioid consumption, length of hospital stay, patient satisfaction, mobility, reduction of costs?
Read the detailed description

Prospective, randomized, double-blinded, single-center, controlled clinical trial with intervention group (SSNB + IPACK, group 1) and control group (FNB + IPACK, group 2), randomization by sealed envelopes.

The number of participants will be 72 per group, calculated based on a sample size calculator program.

The 3 surgeons will be blinded as well as the patients regarding the nerve block they will receive.

We will explain to the patients how both the blocks will be carried out, that 1 block will be located "higher on the leg" and 1 "lower on the leg". The nerve blocks will be carried out by a well-trained anaesthesiologist following standard procedures preoperative.

The IPACK will be applied by the surgeons intraoperative, following a standard protocol. The used implant for all patients will be the cemented ATTUNE™ Primary Knee System® (DePuySynthes Johnson\&Johnson).

Every patient will wear a brace fixed in full extension after surgery for the first 24 hours. Postoperative all patients will receive a standard set of adequate analgesics.

The postoperative rehabilitation program will follow our well-established physiotherapy scheme.

Performed assessments:

  • Range of motion (ROM)
  • medical history
  • physical examinations
  • radiologic controls
  • adverse events
  • falls during hospital stay (standard protocol)
  • pain assessment (numeric rating scale)
  • Questionnaires (EQ-5D-5L und Oxford Knee Score) will be filled in by the patients
  • Functional assessment: Cycle sprint test one a specially instrumented indoor bike (Verve Info Tec PTY LTD) fit with an instrumented crank (InfoCrank Power Meter, Verve Cycling, West Perth, Australia)
  • Functional assessment: Manual muscle testing (MMT)
  • Functional assessment: Timed up and go test (TUG)

Superiority analysis using a two sample t-test, significance level 0.05, power 80%.

Data will be stored electronically in the data base (RedCap). In case of missing data there will always be attempts to obtain these data afterwards (contacting the patients by phone). Further on statistical analysis is performed.

Dropouts, before the 6 weeks follow-up, will be replaced by recruitment of new subjects.

For quality assurance the sponsor, the Ethics Committee or an independent trial monitor may visit the research sites.

Being tested
SSNB + IPACK, FNB + IPACK
Keywords
Subsartorial Saphenous Nerve Block (SSNB), Femoral Nerve Block (FNB), Total Knee Arthroplasty (TKA)
Medical subject headings
Joint Diseases, Arthralgia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SSNB + IPACKOther

    Also called Subsartorial Nerve Block

    already included in arm/group description

  • FNB + IPACKOther

    Also called Femoral Nerve Block

    already included in arm/group description

Study groups in NCT06074744
Study groupRoleWhat they receive
Intervention group: SSNB + IPACK (group 1)Active comparatorSubsartorial Nerve Block: * 15ml bupivacaine 0.5% + clonidine 1mcg/kg for prolongation of the block effect * anatomic landmarks: proximal adductor channel, intersection of the medial borders of the sartorius muscle and the adductor longus, guided by ultrasound control * no patch to puncture site to not jeopardise the surgeon's blinding * IPACK: 15ml bupivacaine 0.5% after completion of the femoral preparation
Receives: Other: SSNB + IPACK
Control group: FNB + IPACK (group 2)Active comparatorFemoral Nerve Block: * 15ml bupivacaine 0.5% + clonidine 1mcg/kg for prolongation of the block effect * anatomic landmarks: lateral to the femoral artery,level of the femoral crease (proximal to the vascular outlet of the deep artery of the thigh), femoral nerve lies on the surface of the iliopsoas muscle and is covered by the fascia iliaca, guided by ultrasound control * no patch to puncture site to not jeopardise the surgeon's blinding * IPACK: 15ml bupivacaine 0.5% after completion of the femoral preparation
Receives: Other: FNB + IPACK

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Functional muscle power output of the leg

    Cycle sprint test measuring maximum lower limb muscle power in Watts (W) from 3 times 10-second maximal efforts (higher values better)

    Measured: preoperative, 6 weeks, 12 weeks, 1 year after surgery

Secondary outcomes (9)
  1. Muscle strength

    Manual muscle testing (MMT) as a standardized measuring tool to assess quadriceps muscle strength using a numeric score 0-5 (Daniels and Worthingham Scale): patient in sitting position in 20 degree knee flexion is asked to extend the knee actively against resistance proximal to the ankle (higher values better)

    Measured: preoperative, 48 hours after surgery, day of discharge (7+/- 2 days postoperative), 6 weeks, 12 weeks, 1 year after surgery

  2. Mobility

    Timed up and go test (TUG): standardized measuring tool, the patient is timed while they rise from an arm chair (approximate seat height 46 cm), walk at a comfortable and safe pace to a line on the floor 3 metres away, turn and walk back to the chair and sit down again (in seconds) (lower values better)

    Measured: preoperative, 48 hours after surgery, day of discharge (7+/- 2 days postoperative), 6 weeks, 12 weeks1 year after surgery

  3. Clinical results

    redness, swelling, hyperthermia, wound/scar, range of motion, stability, adverse events

    Measured: preoperative, day of discharge (7+/- 2 days postoperative), 6, 12 weeks, 1 year after surgery

  4. Radiological results

    x-rays ap and lateral view(1), patella(2), whole leg axis(3)

    Measured: preoperative(1-3), day 1 after surgery(1), 6 weeks(1-2), 1 year after surgery(1-3)

  5. Pain control

    numeric rating scale 0-10 (lower values better)

    Measured: before surgery, twice daily on the ward (except first 6 hours: hourly), day of discharge (7+/- 2 days postoperative), 6 weeks, 12 weeks, 1 year after surgery

  6. Opioid consumption

    documentation of administered drugs including name of drug, dosage, frequency of use

    Measured: before surgery, during hospital stay, day of discharge (7+/- 2 days postoperative), 6 weeks, 12 weeks, 1 year after surgery

  7. Length of hospital stay

    documentation of days in hospital

    Measured: before surgery, during hospital stay, day of discharge (7+/- 2 days postoperative), 6 weeks, 12 weeks, 1 year after surgery

  8. Patient satisfaction 1

    Questionnaire (Oxford Knee Score) 12-60 points (lower values better)

    Measured: preoperative, 6 weeks, 12 weeks, 1 year after surgery

  9. Patient satisfaction 2

    Questionnaire (EQ-5D-5L) 5 questions with 5 answers each (lower values better) including EQ-VAS 0-100 (higher values better)

    Measured: preoperative, 6 weeks, 12 weeks, 1 year after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Oct 2023
  2. Study start30 Nov 2023
  3. Primary completionDec 2026 (estimated)
  4. Study completionDec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
144 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06074744
Sponsor's protocol ID
SSNB2023
Status last verified
Mar 2024
First submitted
23 Aug 2023
Last updated
12 Mar 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Declaration of Helsinki, Version October 2013

  • International Conference on Harmonization (ICH) E6(R2) Guideline for Good Clinical Practice

  • International Conference on Harmonization (ICH, 1997) E8 Guideline: General Considerations for Clinical Trials

  • Implantatregister SIRIS Hüfte und Knie: Kurzfassung - SIRIS Report 2022

  • Bundesamt für Statistik, Schweiz

  • Grosu I, Lavand'homme P, Thienpont E. Pain after knee arthroplasty: an unresolved issue. Knee Surg Sports Traumatol Arthrosc. 2014 Aug;22(8):1744-58. doi: 10.1007/s00167-013-2750-2. Epub 2013 Nov 8.

    PubMed 24201900
  • Burket LW, Greenberg MS, Glick M. Burkett's Textbook of Oral Medicine. 10th ed. Philadelphia, PA: Lippincott

  • Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia: the "3-in-1 block". Anesth Analg. 1973 Nov-Dec;52(6):989-96. No abstract available.

    PubMed 4796576
  • Tierney E, Lewis G, Hurtig JB, Johnson D. Femoral nerve block with bupivacaine 0.25 per cent for postoperative analgesia after open knee surgery. Can J Anaesth. 1987 Sep;34(5):455-8. doi: 10.1007/BF03014348.

    PubMed 3664912
  • Rosenblatt RM. Continuous femoral anesthesia for lower extremity surgery. Anesth Analg. 1980 Aug;59(8):631-2. No abstract available.

    PubMed 7190803
  • Edwards ND, Wright EM. Continuous low-dose 3-in-1 nerve blockade for postoperative pain relief after total knee replacement. Anesth Analg. 1992 Aug;75(2):265-7. doi: 10.1213/00000539-199208000-00020.

    PubMed 1632541
  • Ma HH, Chou TA, Tsai SW, Chen CF, Wu PK, Chen WM. The efficacy of continuous versus single-injection femoral nerve block in Total knee Arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020 Feb 24;21(1):121. doi: 10.1186/s12891-020-3148-1.

    PubMed 32093655
  • Atkinson HD, Hamid I, Gupte CM, Russell RC, Handy JM. Postoperative fall after the use of the 3-in-1 femoral nerve block for knee surgery: a report of four cases. J Orthop Surg (Hong Kong). 2008 Dec;16(3):381-4. doi: 10.1177/230949900801600324.

    PubMed 19126912
  • Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010 Jan;468(1):135-40. doi: 10.1007/s11999-009-1025-1. Epub 2009 Aug 13.

    PubMed 19680735
  • Feibel RJ, Dervin GF, Kim PR, Beaule PE. Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty. 2009 Sep;24(6 Suppl):132-7. doi: 10.1016/j.arth.2009.04.008. Epub 2009 Jun 24.

    PubMed 19553071

Questions about this trial

What is this clinical trial studying?

A study testing SSNB + IPACK and FNB + IPACK in people with Joint Diseases and Joint Pain, run by Luzerner Kantonsspital at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 12 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Judith Bering, Dr. med. (+41 41 205 18 91, judith.bering@luks.ch), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Functional muscle power output of the leg (time frame: preoperative, 6 weeks, 12 weeks, 1 year after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06074744, which also lists 44 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Mar 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in