Adductor Canal Block and Recovery After Total Knee Replacement Surgery (ACB in TKA)

University Health Network, Toronto

Status and phase: Completed; Phase 4

Conditions: Total Knee Arthroplasty

Treatments: Drug: Local Infiltration; Drug: Adductor Canal Block with Morphine; Drug: Adductor Canal Block

Study type: Interventional

Funder types: Other

Identifiers

NCT02411149

13-7016-A

Details and patient eligibility

About

This study aims to compare the functional recovery of patients undergoing Total Knee Arthroplasty based on the administration of an adductor canal block during their anesthesia treatment

Full description

The period after total knee replacement (TKR) surgery is known to be painful for the first 24 hours, lasting up to 3 days in many cases. Successful management of pain after TKR is regarded as necessary to early recovery, rehabilitation and timely discharge. Severe pain following major joint arthroplasty can hinder early rehabilitation, may result in prolonged hospitalization and is a strong predictor of persistent pain beyond 3 months. Adequate analgesia following TKR is paramount to early recovery, rehabilitation and timely discharge. Therefore early postoperative analgesic and rehabilitation goals are intricately related.

Until now, different methods of pain treatment have been used, including intravenous narcotic pain medication, continuous femoral nerve block (numbing medication to a nerve in the thigh) and epidural analgesia (identical to the numbing method for childbirth). These are all effective methods but each is limited by side effects. In recent years, research has focused on administering local anesthetic further down in the leg, trying to minimize quadriceps muscle weakness while giving adequate pain relief after surgery. Local Infiltration Analgesia (LIA) and Adductor Canal Block (ACB) are examples of new farther sites of administration.

The purpose of this study is to determine which combination of analgesic interventions is the most effective treatment for pain and improvement in functional outcome for TKR.

Enrollment: 200 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologists Physical Status I-III
• 18 - 80 years of age
• BMI 18 - 40
• Scheduled for elective total knee replacement under spinal anesthesia
• Able to ambulate independently with a standard wheeled walker as maximum mobility aid

Exclusion criteria

• Revision knee arthroplasty
• Bilateral knee arthroplasty
• Lack of mental ability to provide informed consent
• Neuropathic pain or sensory disorders of the surgical limb
• Contraindication to regional anesthesia (intolerance to the study drugs, bleeding diathesis, coagulopathy, malignancy or infection at the site of block)
• Chronic opioid use defined as > 30 mg of daily oral morphine equivalents

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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200 participants in 3 patient groups, including a placebo group

Local Inflitration Only

Placebo Comparator group

Description:

This group will receive LIA and saline solution (placebo) in the adductor canal block with NO morphine in the spinal anesthesia: * 30 ml normal saline * 3ml 0.5% preservative-free bupivacaine

Treatment:

Drug: Local Infiltration

Adductor Canal Block

Active Comparator group

Description:

This group will receive LIA and the standard local anesthetic in the ACB with NO morphine in the spinal anesthetic: * ropivacaine 0.5% with 1:400,000 epinephrine * 3ml 0.5% preservative-free bupivacaine

Treatment:

Drug: Adductor Canal Block

Adductor Canal Block with Morphine

Active Comparator group

Description:

This group will receive LIA with local anesthetic in the ACB and morphine in the spinal anesthetic: * ropivacaine 0.5% with 1:400,000 epinephrine * 3ml 0.5% preservative-free bupivacaine with 100mcg of intrathecal morphine (0.1ml of intrathecal morphine 1mg/ml)

Treatment:

Drug: Adductor Canal Block with Morphine