Femoral Nerve Block Versus. Adductor Canal Nerve Block for Peri-Operative Analgesia Following Anterior Cruciate Ligament Reconstruction: Evaluation of Post-Operative Pain and Strength
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 78
- 试验地点
- 1
- 主要终点
- Average Pain Level Per Arm on the Visual Analog Scale (VAS) at Post-operative (Day 0), Day 1, Day 2, Day 3.
研究概览
简要总结
All patients over the age of 16 undergoing primary or revision anterior cruciate ligament reconstruction with the use of bone-patellar-bone autograft are eligible for the study. Patients will be randomized pre-operatively to receive either an adductor canal nerve block (single injection) or a femoral nerve block (single injection). Post-operatively, the primary outcome measures of pain level using visual analog scale as well as narcotic and non-narcotic analgesic requirements will be measured.
详细描述
Currently, because of its good track record, femoral nerve block is the modality of choice for post-operative pain control following elective anterior cruciate ligament reconstruction at our institution. It has been proven in the literature to provide good post-operative pain analgesia following this procedure (1). However, femoral nerve block is not without its concerns, including the concern for long-term quadriceps weakness (2). Benefits of decreased use of Femoral Nerve Block include the decreased incidence of side effects and/or complications, and use of quadriceps for immediate rehabilitation. Benefits of Adductor canal nerve block include possible equivalent pain control with the avoidance of motor de-innervation and its deleterious adverse effect of quadriceps weakness postoperatively. Adductor canal nerve block has proven to be effective in other orthopaedic procedures involving the knee including total knee arthroplasty (3). This results of this study will give more information on how to better control pain in the post-op period while minimizing the deleterious side effects for patients undergoing ACLreconstruction.
All patients over the age of 16 undergoing primary or revision anterior cruciate ligament reconstruction with the use of bone-patellar-bone autograft are eligible for the study. Patients will be randomized pre-operatively to receive either an adductor canal nerve block (single injection) or a femoral nerve block (single injection). A single dose of 30 mL of 0.25% marcaine is injected for femoral nerve block and 20 mL of 0.25% marcaine for Adductor Canal nerve block. These procedures will be performed by the attending anesthesiologist prior to surgery. After surgery the patient will record their pain levels using visual analog scale (VAS) score in a daily diary for the first 5 post-operative days. They will also record all medication requirements, both narcotic and non-narcotic analgesic medications. The patient will be tested on their ability to perform a straight leg raise in the post-anesthesia care unit (PACU) and at their first post-operative visit.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Care Provider)
入排标准
- 年龄范围
- 16 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Primary ACL Reconstruction with use of Bone-Patellar-Bone Autograft
- •Age 16 or older
排除标准
- •Patients under 16
- •The use of Allograft,
- •The use of hamstring autograft
- •The use quadriceps autograft
- •Patients allergic to active ingredients in the injection.
研究组 & 干预措施
Adductor Canal Nerve Block
One hour prior to procedure, subject to receive 20 mL of 0.5% ropivacaine injected into the sheath of the saphenous nerve at the adductor hiatus. Ultrasound guidance utilized for appropriate localization of the targeted nerve sheath for local infiltration. No nerve stimulators to be utilized during or after the procedure.
干预措施: Marcaine 0.25 % Injectable Solution (Drug)
Femoral Nerve block
One hour prior to procedure, subject to receive 30 mL of 0.5% ropivacaine injected into the nerve sheath of the femoral nerve at the level of the femoral triangle. Ultrasound guidance utilized for appropriate localization of the targeted nerve sheath for local infiltration. No nerve stimulators to be utilized during or after the procedure.
干预措施: Marcaine 0.25 % Injectable Solution (Drug)
结局指标
主要结局
Average Pain Level Per Arm on the Visual Analog Scale (VAS) at Post-operative (Day 0), Day 1, Day 2, Day 3.
时间窗: Post-operative Day 0, Day 1, Day 2, Day 3
The VAS is a validated self-reported instrument for measuring pain intensity. Possible scores range from 0 (no pain) to 10 (worse possible pain).
Average Narcotic Consumption Per Arm in Morphine Equivalents at Post-operative (Day 0), Day 1, Day 2, Day 3.
时间窗: Post-operative Day 0, Day 1, Day 2, Day 3
Norco 5-325 (hydrocodone with acetaminophen) oral tablet prescribed (1-2 tablets every 4-6 hours as needed for pain) converted to intravenous morphine equivalent dosing.
次要结局
未报告次要终点
研究者
Charles S Day
Orthopedic Surgeon
Henry Ford Health System