Intraoperative Direct vs Postoperative Ultrasound Guided Adductor Canal Nerve Block After Total Knee Arthroplasty

Pontificia Universidad Catolica de Chile

Status: Completed

Conditions: Nerve Block; Knee Osteoarthritis; Total Knee Arthroplasty

Treatments: Procedure: Ultrasound Block; Procedure: Intraoperative Block; Procedure: Intraoperative Placebo; Procedure: Ultrasound Placebo

Study type: Interventional

Funder types: Other

Identifiers

NCT03733509

180620002

Details and patient eligibility

About

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.

Full 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.

Enrollment: 121 patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Primary total knee arthroplasty
• Unilateral
• American Society of Anesthesiologists (ASA) score I, II or III
• Accepts spinal anesthesia

Exclusion criteria

• General anesthesia
• Chronic kidney disease
• Drug or alcohol abuse
• Chronic opioid use
• Allergic to bupivacaine or similar

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

---

121 participants in 2 patient groups

Intraoperative Block

Experimental group

Description:

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%).

Treatment:

Procedure: Ultrasound Placebo

Procedure: Intraoperative Block

Ultrasound Block

Active Comparator group

Description:

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%.

Treatment:

Procedure: Intraoperative Placebo

Procedure: Ultrasound Block