Optimal Volume of Bupivacaine in Adductor Canal Nerve Block
- Conditions
- Anesthesia, Local
- Interventions
- Registration Number
- NCT02557386
- Lead Sponsor
- Pontificia Universidad Catolica de Chile
- Brief Summary
To establish adequate volume of levobupivacaine 0.25% in adductor canal nerve block in unilateral cruciate ligament of the knee reconstruction surgery.
- Detailed Description
The complex knee surgery has been associated with severe postoperative pain. Different analgesic techniques for postoperative management of this increasingly common surgery, with main purpose of adequately control pain, minimizing adverse effects and seeking early rehabilitation.
Currently, the most used technique is the continuous femoral nerve block, which is able to control postoperative pain well, but has the limitation that also produces motor blockade, decreasing quadriceps strength up to 80%, increasing the number of falls and delaying early mobilization after surgery. On the other hand, the adductor canal nerve block is an alternative as it is considered a purely sensitive block. The nerves that are in this channel are the saphenous adductor nerve, posterior branches of the obturator nerve, medial vast nerve, sometimes the medial cutaneous nerve and anterior branches of the obturator nerve and the vast medial nerve.
With regard to the adductor canal block, current literature supports analgesic effect comparable to femoral nerve block with less motor block than femoral nerve block. However, there is no clarity regarding the ideal concentration and volume of local anesthetics to use. Volumes ranging from 5 to 30 ml have been used in different studies. For example, using 20 mL of local anesthetic in femoral nerve block has produced scattering of anesthetic that has blocked motor branches.
The investigators objective is to determine which volume of levobupivacaine 0.25% is necessary to produce analgesia and sensitive blockade while minimizing motor blockade in adductor canal nerve block in patients undergoing cruciate ligament reconstruction surgery.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- Male
- Target Recruitment
- 60
- Male sex
- ASA status I or II
- BMI between 20 and 34 kg/m2
- Cruciate ligament of the knee reconstructive surgery
- No contraindications to general and regional anesthesia
- Chronic pain more than 3 months
- Drug abuse
- Chronic use of analgesic drugs (more than 3 months)
- Psychiatric illness
- Peripheral neuropathy
- Drug allergy
- Severe gastroesophageal reflux disease
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description B Levobupivacaine 10 mL Levobupivacaine 10 mL Adductor canal nerve block with levobupivacaine 0.25% 10 mL and perineural catheter placement, an elastomeric pump with bupivacaine 0.1% at a rate of 5 ml/hr will be placed after surgery for continuous nerve block. C Levobupivacaine 15 mL Levobupivacaine 15 mL Adductor canal nerve block with levobupivacaine 0.25% 15 mL and perineural catheter placement, an elastomeric pump with bupivacaine 0.1% at a rate of 5 ml/hr will be placed after surgery for continuous nerve block. D Levobupivacaine 20 mL Levobupivacaine 20 mL Adductor canal nerve block with levobupivacaine 0.25% 20 mL and perineural catheter placement, an elastomeric pump with bupivacaine 0.1% at a rate of 5 ml/hr will be placed after surgery for continuous nerve block. A Levobupivacaine 5 mL Levobupivacaine 5 mL Adductor canal nerve block with levobupivacaine 0.25% 5 mL and perineural catheter placement, an elastomeric pump with bupivacaine 0.1% at a rate of 5 ml/hr will be placed after surgery for continuous nerve block. E Levobupivacaine 25 mL Levobupivacaine 25 mL Adductor canal nerve block with levobupivacaine 0.25% 25 mL and perineural catheter placement, an elastomeric pump with bupivacaine 0.1% at a rate of 5 ml/hr will be placed after surgery for continuous nerve block. F Levobupivacaine 30 mL Levobupivacaine 30 mL Adductor canal nerve block with levobupivacaine 0.25% 30 mL and perineural catheter placement, an elastomeric pump with bupivacaine 0.1% at a rate of 5 ml/hr will be placed after surgery for continuous nerve block.
- Primary Outcome Measures
Name Time Method Change in quadriceps motor force measured in kg*m/sec2 Before nerve block (basal) and 24 hours after surgery Using a dynamometer in anterior tibial muscle
- Secondary Outcome Measures
Name Time Method Pain Before surgery, 30 minutes after nerve block, one hour after surgery, 48 hours after surgery Using visual analogue scale, static and dynamic evaluation, scale from 0 (no pain) to 10 (worst pain imaginable)
Rescue analgesia 24 hours and 48 hours after surgery Lidocaine 1% bolus through nerve block catheter and opioid use, measured in mg
Patient satisfaction 48 hours after surgery Using a 5 point scale from 1 (very unsatisfied) to 5 (very satisfied)
Change in quadriceps force measured by 30-second chair stand test Before nerve block (basal) and 24 hours after surgery Using 30-second chair stand test, how many times patient can stand up in 30 seconds, number of times is recorded
Sensitivity block 30 minutes after adductor canal block Using a sensitivity scale ranging from 0 (no sensitivity), 1 (paresthesias) and 2 (normal sensitivity. Measured with needle prick and cold sensitivity.
Trial Locations
- Locations (1)
Division de Anestesia - Pontificia Universidad Catolica de Chile
🇨🇱Santiago, Region Metropolitana, Chile