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.

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)