Intraoperative Direct vs Postoperative Ultrasound Guided Adductor Canal Nerve Block After Total Knee Arthroplasty
- Conditions
- Nerve BlockTotal Knee ArthroplastyKnee Osteoarthritis
- Interventions
- Procedure: Ultrasound BlockProcedure: Intraoperative BlockProcedure: Ultrasound PlaceboProcedure: Intraoperative Placebo
- Registration Number
- NCT03733509
- Lead Sponsor
- Pontificia Universidad Catolica de Chile
- Brief Summary
This study compares analgesic effect between two techniques of adductor canal nerve block after total knee arthroplasty. The first group of the patients will receive intraoperative adductor canal nerve block; and the other group post operative ultrasound guided adductor canal nerve block. Investigators will measure postoperative opioid consumption, pain management and rehabilitation goals.
- Detailed Description
Total knee arthroplasty (TKA) is a successful alternative to treat late stage knee osteoarthritis (OA). Pain management has been one of the main focuses of postoperative care. Most surgeons prefer a comprehensive multimodal approach including preoperative pharmacological treatment, intraoperative infiltration with complex drug mixes and postoperative peripheral nerve block.
The most common postoperative nerve block alternative is the proximal femoral nerve block (FNB) which has shown improvements on postoperative pain measured by reduced opioid consumption and decreased pain at rest. Its main detractors argue that the motor nerve block effect is deleterious to early ambulation and have promoted adductor canal nerve blocks (ACB). Described by Lund et al in 2011, ACB block main femoral pain sensory contributors to the knee (articular branches of obturator nerve, vastus medialis branch and saphenous nerve) but is more distal to most motor branches to the quadriceps allowing near to normal quadriceps strength.
Standard ACB block is performed under ultrasound guidance after surgery completion, still in the operating room (OR). Recent literature has shown the anatomic feasibility of intraoperative ACB via blunt suprapatellar dissection in standard medial parapatellar TKA approaches. The study seeks to determine the effectiveness of standard ultrasound guidance ACB compared with intraoperative ACB.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 121
- Primary total knee arthroplasty
- Unilateral
- American Society of Anesthesiologists (ASA) score I, II or III
- Accepts spinal anesthesia
- General anesthesia
- Chronic kidney disease
- Drug or alcohol abuse
- Chronic opioid use
- Allergic to bupivacaine or similar
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intraoperative Block Ultrasound Placebo Before skin closure, blunt suprapatellar dissection proximal to medial femoral condyle towards adductor canal. Nerve block at this level with 20ml of Bupivacaine 0.25%. Postoperatively, mid-thigh ultrasound guided standard adductor canal nerve block with 20ml of saline solution (NaCl 0.9%). Ultrasound Block Ultrasound Block Before skin closure, blunt suprapatellar dissection proximal to medial femoral condyle towards adductor canal. Nerve block at this level with 20ml of of saline solution (NaCl 0.9%). Postoperatively, mid-thigh ultrasound guided standard adductor canal nerve block with 20ml Bupivacaine 0.25%. Ultrasound Block Intraoperative Placebo Before skin closure, blunt suprapatellar dissection proximal to medial femoral condyle towards adductor canal. Nerve block at this level with 20ml of of saline solution (NaCl 0.9%). Postoperatively, mid-thigh ultrasound guided standard adductor canal nerve block with 20ml Bupivacaine 0.25%. Intraoperative Block Intraoperative Block Before skin closure, blunt suprapatellar dissection proximal to medial femoral condyle towards adductor canal. Nerve block at this level with 20ml of Bupivacaine 0.25%. Postoperatively, mid-thigh ultrasound guided standard adductor canal nerve block with 20ml of saline solution (NaCl 0.9%).
- Primary Outcome Measures
Name Time Method 24 hour opioid consumption First 24 hours after surgery Opioid consumption by patient controlled analgesia (PCA) and any other oral or IV analgesics
- Secondary Outcome Measures
Name Time Method 24 patient reported pain First 24 hours after surgery Patient reported pain scale using visual analog scale (VAS) every 6 hours after surgery (0 hours, 6 hours, 12 hours, 18 hours and 24 hours)
Time up and go Test 24 hours after surgery Standardised test to determine patients ability to walk 24 hours after surgery
Range of motion 24 hours after surgery Active and passive knee range of motion
Time to Discharge 7 days Time between surgery and patient in conditions for discharge: no IV requirements, basic walking capability and VAS pain score equal or below 3
Trial Locations
- Locations (1)
Pontificia Universidad Católica de Chile
🇨🇱Santiago, Región Metropolitana, Chile