Pre vs Post Block in Total Knee Arthroplasty (TKA)

Phase 4

Completed

Conditions: Knee Osteoarthritis
Arthroplasty Complications
Postoperative Pain

Interventions: Drug: Dexamethasone
Drug: Acetaminophen
Drug: Lyrica
Drug: Celebrex
Drug: Meloxicam
Drug: Oxycodone
Drug: Ropivacaine

Registration Number: NCT05974501

Lead Sponsor: University of Miami

Brief Summary: The purpose of this project is to determine if a change in patient reported pain, nausea and vomiting after total knee arthroplasty can be observed with the substitution of a post operative adductor canal block for a preoperative adductor canal block in the current established peri-operative pain protocol and if these changes lead to a decrease in opioid consumption (in morphine equivalents).

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 84

Inclusion Criteria

1- Patients 18 or older 2 - Patients undergoing primary total knee replacement at the University of Miami Hospital 3 - Patients that have capacity to provide medical consent

Exclusion Criteria

All patients under the age of 18
Prisoners, uncontrolled diabetics, increased risk of bleeding, pregnant women, women planning on becoming pregnant in the next year, and women who think they might be pregnant.
Patients with prior surgery or history of infection on the joint of interest.
Patients on steroid preoperatively.
Inability to provide medical consent.
Patients with a history of significant unmitigated pain in parts of their body not including the knee the procedure is to be performed or a history of pain catastrophizing (the tendency to magnify the threat value of the pain stimulus and to feel helpless in the context of pain, and by a relative inability to inhibit pain-related thoughts in anticipation of, during or following a painful event) regarding pain anywhere in the body.
Any condition that, in the opinion of the investigator, would compromise the well-being of the patient or the study or prevent the patient from meeting or performing study requirements will exclude the participant.
Allergy to local anesthetic or any medication used in the standard protocol for joint replacement.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Preoperative Adductor Canal Block Group	Dexamethasone	Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.
Preoperative Adductor Canal Block Group	Acetaminophen	Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.
Preoperative Adductor Canal Block Group	Lyrica	Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.
Postoperative Adductor Canal Block Group	Dexamethasone	Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours
Postoperative Adductor Canal Block Group	Acetaminophen	Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours
Postoperative Adductor Canal Block Group	Lyrica	Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours
Postoperative Adductor Canal Block Group	Meloxicam	Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours
Preoperative Adductor Canal Block Group	Celebrex	Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.
Preoperative Adductor Canal Block Group	Meloxicam	Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.
Preoperative Adductor Canal Block Group	Oxycodone	Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.
Preoperative Adductor Canal Block Group	Ropivacaine	Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.
Postoperative Adductor Canal Block Group	Ropivacaine	Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours
Postoperative Adductor Canal Block Group	Celebrex	Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours
Postoperative Adductor Canal Block Group	Oxycodone	Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours

Primary Outcome Measures

Name	Time	Method
Pain Status as Measured by Numeric Pain Scale	24 hours postoperatively	Scale with numeric scores ranging from 0 (least) to 10 (most) pain

Secondary Outcome Measures

Name	Time	Method
Episodes of Nausea	24 hours postoperatively	Count of the number of episodes of nausea per patient
Episodes of Vomiting	24 hours postoperatively	Count of the number of episodes of vomiting per patient
Discharges by Midnight on POD1	Up to 48 hours postoperatively	The number of patients discharged home by midnight postoperative day one
Patients Reporting Nausea	24 hours postoperatively	Count of the number of patients reporting nausea
Hours Hospitalized	Up to 336 hours postoperatively	Number of hours hospitalized
Discharges by Midnight POD0	Up to 24 hours postoperatively	The number of patients discharged home by midnight on postoperative day zero
Patients Reporting Vomiting	24 hours postoperatively	Count of the number of patients reporting vomiting
Total Opioid Consumption	24 hours postoperatively	Measure of the amount of morphine milliequivalents consumed by the patient
Nights Hospitalized	Up to 14 nights postoperatively	Number of nights hospitalized