Low vs Standard Local Anesthetics Boluses for Continuous Adductor Canal Block in Total Knee Arthroplasty
- Conditions
- Knee Arthropathy
- Interventions
- Drug: Low bolus concentration and volume
- Registration Number
- NCT06179628
- Lead Sponsor
- Chulalongkorn University
- Brief Summary
To investigate the efficacy of two different regimens of local anesthetic boluses for continuous adductor canal block under ultrasound-guidance in total knee arthroplasty at King Chulalongkorn Memorial Hospital.
- Detailed Description
Total knee arthroplasty (TKA) is a commonly performed surgical procedure for patients with severe knee osteoarthritis. However, one of the challenges associated with TKA is the significant postoperative pain experienced by patients, which can delay early mobilization and physical therapy. Uncontrolled pain worsens patient outcomes and healthcare costs as it can increase the risk of complications after surgery. Therefore, effective pain management is important for optimizing patient outcomes and promoting a smooth recovery process.Despite the absence of a standardized recommendation for the volume and concentration of bolus administration in continuous adductor canal block (CACB), many previous studies, have demonstrated the efficacy of a high-dose bolus followed by a low-concentration local anesthetic infusion for CACB. However, these trials exhibited differences in the doses and volumes of bolus injection. Therefore, the necessity of high concentration and volume bolus CACB in combination with comprehensive multimodal analgesia and LIA for postoperative pain management in TKA remains uncertain. The aim of this study is to investigate the efficacy of two different regimens of local anesthetic used in boluses for continuous adductor canal block under ultrasound-guidance in total knee arthroplasty at King Chulalongkorn Memorial Hospital.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 140
- Patients undergoing TKA aged more than 18 years
- Patients with American Society of Anesthesiologists (ASA) class 1-3
- Patients with body weight index (BMI) 18-40 kg/m2
Exclusion Criteria
- Patient refusal to participate
- Patients with known allergic to medications used in the research protocol
- Patients with contraindications to neuraxial or regional anesthesia, including existing neuropathy or neurological deficits involving the lower extremities, coagulopathy or bleeding diathesis and local skin infections
- Patients with contraindications to NSAIDs such as history of coronary artery bypass graft surgery, congestive heart failure, stroke, gastrointestinal bleedings or ulceration, asthma, hepatic and renal disease, abnormal coagulation, or pregnancy
- Patients with chronic opioid use (opioids have been used daily or almost daily for more than three months or sixty milligrams or more of morphine has been used daily for more than one month) or diagnosed with neuropathic pain
- Patients that are unable to perform preoperative Quantitative sensory testing.
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Low Concentration and Volume Low bolus concentration and volume 0.15% bupivacaine 10 ml boluses for continuous adductor canal block Standard Concentration and Volume Low bolus concentration and volume 0.25% bupivacaine 20 ml boluses for continuous adductor canal block
- Primary Outcome Measures
Name Time Method Average knee pain score assessed by Numerical rating scale (NRS) 12 hours after surgery Average postoperative pain score assessed by NRS from 0-10 (0= no pain, 10= the worst pain imaginable)
- Secondary Outcome Measures
Name Time Method Functional outcomes assessed by Five Times Sit to Stand Test (5XSST) preoperative - postoperative day 2 Evaluate patient's functional outcomes by 5XSST at preoperative and postoperative day 0,1,2
Functional outcomes assessed by Time Up and Go (TUG) test preoperative - postoperative day 2 Evaluate patient's functional outcomes by TUG tests at preoperative and postoperative day 0,1,2
The degree of active range of motion (ROM) of knee joint preoperative - postoperative day 2 Evaluate patient's functional outcomes by the degree of knee active ROM (measured by a goniometer) at preoperative and postoperative day 0,1,2
Quadriceps strength assessed by maximum voluntary isometric contraction (MVIC) in Newton preoperative - postoperative day 2 Quadriceps strength assessed by MVIC in Newton at 90 degrees at preoperative and postoperative day 0,1,2
morphine consumption in milligrams post0perative day 0-2 Patient's morphine consumption at postoperative day 0,1,2
Postoperative pain score assessed by Numerical rating scale (NRS) preoperative to day 7 after hospital discharge Postoperative pain score at rest and on movement assessed by NRS from 0-10 (0= no pain, 10= the worst pain imaginable)
postoperative complications assessed by Likert scale postoperative day 0-2 postoperative complications such as nausea/vomitting, sleep disturbance and fall assessed by Likert scale from 1-7 (1 = strongly disagree/ extremely unlikely, 2 = disagree/ unlikely, 3 = slightly disagree/ slightly unlikely, 4 = either, 5 = slightly agree/ slightly likely, 6 = agree/ likely, 7 = strongly agree/ extremely likely)
The time to first rescue analgesia postoperative day 0-2 the period from the CACB administration to the first IV morphine administration
Trial Locations
- Locations (1)
Chulalongkorn University
🇹🇭Bangkok, Thailand
Chulalongkorn University🇹🇭Bangkok, Thailand