Postoperative Pain Management Following Total Knee Arthroplasty Utilizing Adductor Canal Block: Effects on Pain Management and Quadriceps Sparing
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 发起方
- 入组人数
- 33
- 试验地点
- 2
- 主要终点
- Quadriceps function as assessed by non-invasive transcutaneous nerve stimulation of the femoral nerve
研究概览
简要总结
The purpose of this study is to investigate whether there is quantitative motor-sparing of the quadriceps muscles following adductor canal nerve block versus femoral nerve block. Patients will be randomly placed into one of three treatment groups: 1) Femoral nerve block, 2) Adductor canal nerve block - low volume, or 3) Adductor canal nerve block - high volume. Quadriceps function will be assessed in the operating room using a skin patch and electrical stimulation. Follow up visits with the patients will continue over the course of 2 days during patient's stay at the hospital. A total of 60 patients will be enrolled for the study.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients undergoing primary unilateral total knee arthroplasty
- •Planned use of combined spinal epidural (CSE) anesthesia
- •Ability to follow study protocol
排除标准
- •Contraindication to a spinal or epidural anesthetic
- •Chronic opioid use (defined as daily or almost daily use of opioids for >3 months)
- •Allergy to local anesthetics
- •Pre-existing neuropathy or weakness of the operative limb
- •Any neuromuscular disorder
- •Diabetes type I and II
- •Contraindication to a femoral nerve block or adductor canal nerve block
- •Allergy or intolerance to any of the study medications
- •BMI > 35 kg/m2
结局指标
主要结局
Quadriceps function as assessed by non-invasive transcutaneous nerve stimulation of the femoral nerve
时间窗: 15 minutes after the placement of the peripheral nerve block (femoral or adductor canal)
After CSE effect, but prior to peripheral block, quadriceps function will be assessed by non-invasive transcutaneous nerve stimulation of the femoral nerve by placing an ECG electrode over the femoral location (determined by U/S) in the inguinal groove. The threshold amperage that produces patellar motion in response to electrical stimulation will be recorded. This threshold amperage will serve as a baseline value. Following the peripheral nerve block, transcutaneous stimulation will be repeated and, if still possible to elicit quadriceps contractions in response to electrical stimulation, the resulting new threshold amperage will be measured. The new threshold amperage will be expressed as a percentage of the baseline value and serve as a quantitative functional indication of the extent of quadriceps paresis resulting from the peripheral nerve block. The primary outcome will be quadriceps paralysis - yes/no.
次要结局
- Threshold amperage as a percentage of the baseline value(15 minutes after the placement of the peripheral nerve block)
- Analgesic adequacy(Resolution of the spinal anesthetic (2 hours post-op), 24 and 48 hours post-op)
- Ability to complete a straight leg lift(Holding area (baseline), at spinal resolution (2 hours post-op), 24 hours post-op and 48 hours post-op)