Popliteal Nerve Block for Acute Achilles Tendon Rupture Repair Surgery
The Effects of Popliteal Nerve Block on Pain and Nerve-Related Symptoms After Acute Achilles Tendon Rupture Repair Surgery: A Randomized Controlled Trial
Women's College Hospital
80 participants
Feb 1, 2026
INTERVENTIONAL
Conditions
Summary
Achilles tendon rupture is common, yet the value of popliteal nerve block for postoperative pain control during surgical repair remains uncertain. Despite widespread use, evidence supporting its analgesic effectiveness is limited, and both popliteal nerve block and Achilles tendon repair carry risks of nerve injury. This randomized, placebo-controlled trial will evaluate whether adding a popliteal nerve block to standard systemic analgesia improves postoperative pain and reduces opioid use in patients undergoing acute Achilles tendon rupture repair. Secondary outcomes will examine the incidence and impact of nerve complications on recovery, including return to physical activity and functional performance.
Eligibility
Inclusion Criteria4
- Age 18 - 65
- ASA classification: I - III
- BMI \< 35 kg/m2
- Undergoing acute Achilles tendon rupture repair surgery as a day surgery procedure
Exclusion Criteria12
- Pre-existing neurological deficits or peripheral neuropathy in the distribution of the tibial or common peroneal nerves
- Local infection
- Contraindication to regional anesthesia (e.g., bleeding diathesis, coagulopathy)
- History of use of over 30 mg oxycodone or equivalent per day
- Contraindication to any component of a standard multi-modal analgesia
- Allergy to local anesthetics
- History of significant psychiatric conditions that may affect patient assessment
- Pregnancy
- Inability to provide informed consent
- Patient refusal of popliteal nerve blockade
- Prior Achilles tendon surgeries on the operative leg
- Unable to speak or read English
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Interventions
Under ultrasound guidance, a 22G, 80-mm echogenic needle (SonoTAP II, Pajunk Medical Systems, USA) will be inserted using an in-plane lateral-to-medial approach. 30 mL of 0.5% ropivacaine with 2.5 µg/ml of epinephrine will be deposited between tibial and common peroneal nerves within the paraneural sheath. Adequate spread of local anesthetics will be confirmed by visualization of paraneural spread.
Patients in the Control group will receive sham blocks using a 25G needle to inject 1 mL of saline subcutaneously in the same location (popliteus of the surgical knee). Sterilization and ultrasound scanning will match actual PN block. Such a non-invasive placebo allows maintaining patient blinding, while reducing the risks associated with high-volume placebo nerve block injections. The ultrasound screen will be blinded from the patient's vision for all patients in the trial to prevent unblinding by patients with knowledge of the technique.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT06886815