Adductor Canal Block and Recovery After Total Knee Replacement Surgery
- Conditions
- Total Knee Arthroplasty
- Interventions
- Drug: Adductor Canal BlockDrug: Local InfiltrationDrug: Adductor Canal Block with Morphine
- Registration Number
- NCT02411149
- Lead Sponsor
- University Health Network, Toronto
- Brief Summary
This study aims to compare the functional recovery of patients undergoing Total Knee Arthroplasty based on the administration of an adductor canal block during their anesthesia treatment
- Detailed Description
The period after total knee replacement (TKR) surgery is known to be painful for the first 24 hours, lasting up to 3 days in many cases. Successful management of pain after TKR is regarded as necessary to early recovery, rehabilitation and timely discharge. Severe pain following major joint arthroplasty can hinder early rehabilitation, may result in prolonged hospitalization and is a strong predictor of persistent pain beyond 3 months. Adequate analgesia following TKR is paramount to early recovery, rehabilitation and timely discharge. Therefore early postoperative analgesic and rehabilitation goals are intricately related.
Until now, different methods of pain treatment have been used, including intravenous narcotic pain medication, continuous femoral nerve block (numbing medication to a nerve in the thigh) and epidural analgesia (identical to the numbing method for childbirth). These are all effective methods but each is limited by side effects. In recent years, research has focused on administering local anesthetic further down in the leg, trying to minimize quadriceps muscle weakness while giving adequate pain relief after surgery. Local Infiltration Analgesia (LIA) and Adductor Canal Block (ACB) are examples of new farther sites of administration.
The purpose of this study is to determine which combination of analgesic interventions is the most effective treatment for pain and improvement in functional outcome for TKR.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 200
- American Society of Anesthesiologists Physical Status I-III
- 18 - 80 years of age
- BMI 18 - 40
- Scheduled for elective total knee replacement under spinal anesthesia
- Able to ambulate independently with a standard wheeled walker as maximum mobility aid
- Revision knee arthroplasty
- Bilateral knee arthroplasty
- Lack of mental ability to provide informed consent
- Neuropathic pain or sensory disorders of the surgical limb
- Contraindication to regional anesthesia (intolerance to the study drugs, bleeding diathesis, coagulopathy, malignancy or infection at the site of block)
- Chronic opioid use defined as > 30 mg of daily oral morphine equivalents
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Adductor Canal Block Adductor Canal Block This group will receive LIA and the standard local anesthetic in the ACB with NO morphine in the spinal anesthetic: * ropivacaine 0.5% with 1:400,000 epinephrine * 3ml 0.5% preservative-free bupivacaine Local Inflitration Only Local Infiltration This group will receive LIA and saline solution (placebo) in the adductor canal block with NO morphine in the spinal anesthesia: * 30 ml normal saline * 3ml 0.5% preservative-free bupivacaine Adductor Canal Block with Morphine Adductor Canal Block with Morphine This group will receive LIA with local anesthetic in the ACB and morphine in the spinal anesthetic: * ropivacaine 0.5% with 1:400,000 epinephrine * 3ml 0.5% preservative-free bupivacaine with 100mcg of intrathecal morphine (0.1ml of intrathecal morphine 1mg/ml)
- Primary Outcome Measures
Name Time Method Timed Up and Go test 2-3 days post srugery TUG test reflects the time it takes a subject to stand up from a standard height armchair, walk 3 meters, walk back to the chair and sit down. It intends to assess a patient's global mobility as well as balance and risk of falling.
- Secondary Outcome Measures
Name Time Method Pain outcome - NRS 2-3 days post surgery a) Pain scores assessed with an 11 point verbal numeric rating scale (NRS) where 0 is "no pain" and 10 is "the worst pain imaginable", both at rest and during active physiotherapy (measured daily for 3 days post-operatively) .
Analgesic outcomes - Cumulative systemic opioid consumption 2-3 days post surgery Cumulative systemic opioid consumption measured as oral morphine mg equivalents (daily for 3 days post-operatively).
Analgesic outcomes - Proportion of patients who required "rescue" intravenous patient controlled analgesia 2-3 days post surgery Proportion of patients who required "rescue" intravenous patient controlled analgesia (iv PCA) anytime in the post-operative period.
Analgesic outcomes - Incidence of opioid-related side effects 2-3 days post surgery Incidence of opioid-related side effects
Secondary short-term physical and performance-based functional outcome measures - Proportion of patients achieving knee flexion range of motion (ROM) of 90 degrees 2-3 days post surgery Proportion of patients achieving knee flexion range of motion (ROM) of 90 degrees (measured daily for 3 days post-operatively)
Secondary short-term physical and performance-based functional outcome measures - Distance walked 2-3 days post surgery Distance walked
Secondary short-term physical and performance-based functional outcome measures - Hospital length of stay 2-3 days post surgery Hospital length of stay
Secondary short-term physical and performance-based functional outcome measures - Discharge destination 2-3 days post surgery Discharge destination (home or rehabilitation facility)
Medium-term self-reported functional outcome measures - WOMAC baseline and 2-3 days post surgery Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and at 3 months post-operatively
Medium-term self-reported functional outcome measures - LEFS baseline and 2-3 days post surgery Lower extremity functional scale (LEFS) measured at baseline and at 3 months post-operatively.
Trial Locations
- Locations (1)
Toronto Western Hospital
🇨🇦Toronto, Ontario, Canada