Impact of Adductor Canal Block on Functional Recovery

Not Applicable

• Conditions: Total Knee Replacement

• Registration Number: NCT04814303
• Lead Sponsor: Assiut University

Brief Summary

TKA involves extensive bone resection as well as soft tissue excision and therefore is associated with profound postoperative pain. Adequate analgesia after TKA is therefore considered paramount to facilitate early hospital discharge and effective functional recovery.

Detailed Description

Osteoarthritis (OA) of the knee has become a major public health issue and imposes a significant healthcare burden and accounts for high annual hospitalizations. Chronic OA of the knee may lead to reduced physical fitness, mobility disability with a resultant increased risk of cardio-metabolic comorbidity and early mortality. Total knee arthroplasty (TKA) is indicated in severe cases to improve long-term pain and function. (1) TKA involves extensive bone resection as well as soft tissue excision and therefore is associated with profound postoperative pain. (2) Inadequate perioperative pain control may prolong hospitalization, hinder early rehabilitation, and is also a strong predictor of persistent pain beyond 3 months. (3) Adequate analgesia after TKA is therefore considered paramount to facilitate early hospital discharge and effective functional recovery. (4) The recently introduced adductor canal block (ACB) typically covers the anterio-medial aspect of the knee and preserves quadriceps function, which presumably enhances postoperative rehabilitation by allowing patients to actively participate in knee movement. The relative effectiveness of this ACB technique added to intrathecal morphine is limited to a single study (1) in which assessment of short-term functional recovery was done and dexamethasone was neither included in the LIA solution nor perineurally in the ACB. Thus, we hypothesize that adductor canal block as an adjunct to intrathecal morphine will have a better impact on functional recovery than peri-articular infiltration.

Study Timeline

• Status Verified: 2021-03
• Study First Submitted: 2021-03-22
• Study First Submitted QC: 2021-03-22
• Last Update Submitted: 2021-03-22
• Study First Posted: 2021-03-24
• Last Update Posted: 2021-03-24
• Study Start: 2021-05
• Primary Completion: 2022-05
• Study Completion: 2022-08

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 200

Inclusion Criteria

• American Society of Anesthesiologist class ( ASA) I - III
• BMI 18-35 kg/m2
• Scheduled for primary unilateral TKR

Exclusion Criteria

• Known allergy to local anesthetics
• Contraindication to adductor canal block e.g. infection at the site of injection
• Contraindication to spinal anesthesia e.g. coagulopathy.
• Patients with pre-existing motor or sensory deficits in lower extremities.
• Patients who are morbidly obese (BMI≥35) because ultrasound-guided regional anesthesia could be technically difficult.
• Bilateral or revision total knee replacement
• Insulin or noninsulin-dependent diabetes mellitus.
• systemic corticosteroid use within 30-days of surgery

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
"Timed Up and Go" test (TUG)	48 hours	reflects the time it takes a subject to stand up from a standard-height armchair, walk 3 m, walk back to the chair, and sit down.

Secondary Outcome Measures

Name	Time	Method
Visual analogue scale (VAS) at rest	72 hours	will be used to assess knee pain intensity
Visual analogue scale (VAS) at movement	72 hours	will be used to assess knee pain intensity
Time to first analgesic request	72 hours	the first time the patient ask for analgesia
Total analgesic consumption	72 hours	Total consumption of postoperative rescue analgesics (total of paracetamol doses) will be recorded