Comparison of a four-nerve block protocol versus adductor canal block plus local infiltration analgesia for primary total knee arthroplasty in two French private hospitals: protocol for the multicentre randomised INCA trial
Abstract
Background: INCA is a multicentre, prospective, randomised, two-arm superiority trial. 100 adult patients scheduled for primary total knee arthroplasty (TKA) will be randomised 1:1 to one of two locoregional analgesia strategies: group 1 (standard strategy), single-shot adductor canal block (ACB) combined with active surgeon-administered peri-articular infiltration with ropivacaine and participant-facing sham peripheral nerve blocks; group 2 (four-nerve block strategy), single-shot ACB combined with three additional ultrasound-guided nerve blocks (lateral femoral cutaneous, obturator and infiltration between the popliteal artery and capsule of the knee (IPACK) blocks) plus sham surgical infiltration. All patients will receive general anaesthesia and identical systemic multimodal analgesia (paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), nefopam and rescue opioids) so that any between-group differences can be attributed to the allocated regional strategy. The primary outcome is global recovery at 24 hours, assessed by the Quality of Recovery-15 (QoR-15) questionnaire. Secondary outcomes include postoperative pain scores, opioid consumption, rescue analgesia including any rescue infiltration, motor function and adverse events, range of motion of the index knee, time to first ambulation, postanaesthesia care unit (PACU) stay, hospital length of stay, QoR-15 at 48 hours and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) at 1 month.
Methods:…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 100 participants or records.
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