Adductor Canal Block Versus Periarticular Bupivicaine Injection in Total Knee Arthroplasty
Overview
- Phase
- Phase 4
- Intervention
- Bupivacaine
- Conditions
- Osteoarthritis
- Sponsor
- Columbia University
- Enrollment
- 155
- Locations
- 1
- Primary Endpoint
- Change in VAS Pain Scores
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
The objective of the study is to compare the efficacy of adductor canal blocks versus periarticular bupivacaine injections for pain management in total knee arthroplasty. This randomized clinical trial will compare outcomes between adductor canal blocks, periarticular bupivacaine injections, and periarticular liposomal bupivacaine injections. Results from this study will help determine the most appropriate perioperative pain management strategy for patients undergoing a total knee arthroplasty.
Detailed Description
Over 600,000 total knee arthroplasties (TKAs) are performed each year in the United States, with expectations for greater than 4 million/year by the year 2030. Since the onset of TKAs in the 1960's, there have been developments that have improved both functionality and patient satisfaction. In the last decade, a focus has been made on multimodal pain management protocols, more rapid functional recovery, reduced length of hospital stay, and minimizing side effects of treatment while maintaining function and durability. The widespread use of regional anesthesia has led to improvements in pain control, more rapid functional recovery, and reduced length of stay. In recent years many surgeons have transitioned from femoral nerve blocks (proximal femoral nerve) to adductor canal blocks (distal femoral nerve) to maintain a sensory block for pain control, while minimizing any motor blockade that is typically seen in proximal femoral nerve blocks, which would hamper rehabilitation, and increase risk of falls. In addition to regional blocks, which are typically performed in the preoperative setting, some surgeons favor an intraoperative periarticular anesthetic injection (PAI), typically with bupivacaine or the long acting form liposomal bupivacaine, either in conjunction with an adductor canal block, or independently. In theory, PAI has the advantage of a comparable sensory nerve block as an adductor canal block, without the disadvantages and risks, which include prolonged quadriceps weakness, fall risk, and neurologic dysfunction. The purpose of this randomized control trial is to compare the efficacy of adductor canal blocks versus periarticular bupivacaine injections for pain management in total knee arthroplasty.
Investigators
Jeffrey Geller
Associate Professor of Orthopedic Surgery at the Columbia University Medical Center
Columbia University
Eligibility Criteria
Inclusion Criteria
- •Patients undergoing an unilateral primary total knee arthroplasty under the care of the two senior arthroplasty surgeons.
Exclusion Criteria
- •Allergy to bupivicaine or liposomal bupivicaine.
Arms & Interventions
Adductor Canal Block
15 cc's of 0.5% bupivacaine preoperatively administered by the regional pain anesthesia team in the pre-operative block area, just prior to surgery. Adductor Canal Block (ACB)
Intervention: Bupivacaine
Periarticular SB
50 cc's of 0.25% bupivacaine will be injected intraoperatively, just prior to wound closure, by the performing surgeon.
Intervention: Bupivacaine
ACB + SB
15 cc's of 0.5% bupivacaine preoperatively administered by the regional pain anesthesia team in the pre-operative block area, just prior to surgery. 50 cc's of 0.25% bupivacaine will be injected intraoperatively, just prior to wound closure, by the performing surgeon.
Intervention: Bupivacaine
Outcomes
Primary Outcomes
Change in VAS Pain Scores
Time Frame: Day 0 through Day 3
Post-operatively, visual analog scale (VAS) pain scores will be recorded two times/day from Post-Operative Day (POD) 0 through POD3. VAS Scores range from 0 to 10, with 0 being "No Pain" and 10 being the "Worst Pain"
Secondary Outcomes
- Range of Knee Flexion(Postoperative day 21)
- Length of Hospital Stay(Up to Day 5)
- Change in Activity Level(Day 0 and Day 1)
- Opioid Consumption(Day 0 through Day 3)