A Novel Analgesia Technique for ACL Reconstruction

Hospital for Special Surgery (HSS)

Status and phase: Completed; Phase 4

Conditions: Anterior Cruciate Ligament Injury

Treatments: Drug: Bupivacaine; Drug: Dexamethasone; Device: Ultrasound

Study type: Interventional

Funder types: Other

Identifiers

NCT03292926

2017-0934

Details and patient eligibility

About

A comparison of two anesthetic techniques-- the Adductor Canal Block (ACB) and the Adductor Canal Block with Infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (ACB/IPACK)-- in patients undergoing bone-tendon-bone (BTB) anterior cruciate ligament (ACL) reconstruction.

Enrollment: 78 patients

Sex: All

Ages: 13 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients undergoing BTB ACL reconstruction with participating surgeon
• Age 13 or greater
• Planned use of regional anesthesia
• Ability to follow study protocol
• English speaking (secondary outcomes include questionnaires validated in English only)

Exclusion criteria

• Hepatic or renal insufficiency
• Younger than 13 years old
• Patients undergoing general anesthesia
• Allergy or intolerance to one of the study medications
• BMI > 40
• Diabetes
• American Society of Anesthesiology (ASA) score IV
• Chronic gabapentin/pregabalin use (regular use for longer than 3 months)
• Chronic opioid use (taking opioids for longer than 3 months, or daily morphine equivalent of >5mg/day for one month)
• Non-English speaking

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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78 participants in 2 patient groups

Adductor Canal Block (ACB)

Active Comparator group

Description:

The adductor canal block will be ultrasound-guided sonosite. The anesthesiologist will administer 15 cc bupivacaine 0.5% with 2 mg preservative-free dexamethasone with a 22 gauge (G)/4 inch Chiba needle to the mid-thigh of the surgical limb while subject lays in the supine position post IV sedation.

Treatment:

Device: Ultrasound

Drug: Dexamethasone

Drug: Bupivacaine

Adductor Canal Block & IPACK (ACB/IPACK)

Active Comparator group

Description:

The adductor canal block will be ultrasound-guided. The anesthesiologist will administer 15 cc bupivacaine 0.5% with 2 mg preservative-free dexamethasone with a 22G/4 inch Chiba needle to the mid-thigh of the surgical limb while subject lays in the supine position post IV sedation. The IPACK will be ultrasound-guided with c60 sonosite probe (5-2Hz). While laying in the prone or supine, frog-leg position the IPACK will be administered using a 22G/4inch Chiba needle. The anesthesiologist will identify the popliteal artery at the popliteal crease and move cephalad just beyond the femoral condyles at the confluence with the femur. Then the anesthesiologist will identify the space between the femur and the popliteal artery and moving from medial to lateral place the needle in between the popliteal artery and femur with the tip ending 2-3 cm lateral to the artery and inject 25 cc bupivacaine 0.25% with 2 mg preservative-free dexamethasone.

Treatment:

Device: Ultrasound

Drug: Dexamethasone

Drug: Bupivacaine