Location of Injection of Local Anesthetics in the Adductor Canal Block
- Conditions
- AnesthesiaAdductor Canal Block
- Interventions
- Registration Number
- NCT02554864
- Lead Sponsor
- Women's College Hospital
- Brief Summary
The adductor canal block (ACB) is the standard of care for analgesia after Anterior Cruciate Ligament (ACL) repair. ACB is performed by injecting local anesthetic (freezing) in the subsartorial canal in the thigh which is about 7-10cm long. Preliminary evidence suggests that different injection sites within the canal may produce different degrees of analgesia and quadriceps motor block. This trial seeks to determine the effects of various ACB injection sites on postoperative analgesia and motor power following ACL repair.
- Detailed Description
Adductor canal block (ACB) is replacing femoral nerve block (FNB) as the peripheral nerve block of choice for knee surgery. The ACB aims to inject local anesthetics (LA) within the neurovascular sheath in the subsartorial adductor canal around the femoral nerve. The point where the sartorius muscle crosses over the femoral artery is generally the accepted site for performing ACB. Clinically, injecting LA in the adductor canal blocks the sensory innervation of the knee and thus offers pain relief that is similar to FNB while conserving motor power around the knee. While these benefits are desirable, the exact location for performing ACB that ensures these benefits, remains debatable. The subsartorial adductor canal itself is 7-10cm long and the anatomical location of the sensory and motor nerves that innervate the knee and its surrounding muscles in this canal may vary. This randomized controlled trial is designed to identify and refine the ACB technique by clinically determining the effects of various ACB injection locations on postoperative analgesia and quadriceps motor power following ACL repair.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 108
- Patients booked for anterior cruciate ligament surgery under general anesthesia
- English speaking
- BMI <38 kg/m2
- Refusal or inability to provide informed consent
- Allergy to local anesthetics
- Contraindication to regional anesthesia including coagulopathy or bleeding - diathesis
- Infection
- Nerve Injury at the site of the nerve block
- Malignancy at the site of the nerve block
- History of drug and/or alcohol dependence
- History of long term opioid intake or chronic pain disorder
- History of pre-existing neuropathy in the operative leg
- History of significant psychiatric conditions that may affect patient assessment
- Inability to understand the informed consent and demands of the study
- Allergy to any of the components of multi-modal analgesic regimen
- Revision ACL repair
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Adductor Canal Block- Injection -Site A lidocaine AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site A - after the sartorius muscle crosses over the femoral artery Adductor Canal Block- Injection -Site A ropivacaine AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site A - after the sartorius muscle crosses over the femoral artery Adductor Canal Block - Injection -Site B lidocaine AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site B - before the sartorius muscle crosses over the femoral artery Adductor Canal Block -Injection -Site C ropivacaine AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site C - as the sartorius muscle crosses over the femoral artery Adductor Canal Block - Injection -Site B ropivacaine AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site B - before the sartorius muscle crosses over the femoral artery Adductor Canal Block -Injection -Site C lidocaine AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site C - as the sartorius muscle crosses over the femoral artery
- Primary Outcome Measures
Name Time Method Cumulative 24 Hour Oral Morphine Equivalent Consumption 24 hours Post-Operative Analgesia
Motor Power - Peak Force as measured by a dynamometer 30 Minutes post Block Percentage decrease in quadriceps motor strength at 30 minutes following adductor canal block compare to baseline
- Secondary Outcome Measures
Name Time Method Opioid Consumption During surgical procedure Intra-operative opioid consumption
Total opioids in Post Anesthetics (PAC) Total length of time in PACU (total time in minutes from arrival in PACU to discharge to the Surgical Day Care is between 60-180 minutes Cumulative oral morphine equivalent consumption in PACU
Pain Scores - Questionnaire 24 hours post block Area under the curve for rest pain scores plotted against time during the first 24 hours
Patient Satisfaction - Questionnaire 24 hours postoperatively Patient satisfaction with analgesia - NRS Pain Scale 0(no pain to 10(worst pain)
Hospital Discharge (Time to hospital discharge) Same day as surgical procedure Time to hospital discharge
Nerve Block Complications 24 hours postoperatively and 2 weeks postoperatively Presence/absence of nerve block complications during the first 24 hours postoperatively and 2 weeks after surgery
Quality of Recovery (QoR-15) 24 hours postoperatively Quality of recovery measured using the QoR-15 at 24 hours postoperatively
Trial Locations
- Locations (1)
Women's College Hospital
🇨🇦Toronto, Ontario, Canada