Knee Arthroscopy for Pain Control

The University of Alabama at Birmingham

Status: Begins enrollment in 11 months

Conditions: Knee Arthroscopy

Treatments: Procedure: Nerve Block; Procedure: Portal Anesthesia

Study type: Interventional

Funder types: Other

Identifiers

NCT06701175

IRB-300013299

UAB (Other Grant/Funding Number)

Details and patient eligibility

About

This study aims to determine the effectiveness of an anterolateral genicular nerve block and portal anesthesia in controlling pain in the perioperative period after knee arthroscopy. Opioid consumption, the use of non-opioid medications, complication rate, and sleep quality will also be measured.

Full description

Orthopaedic surgeries are some of the most painful operations to recover from, especially when involving cruciate ligaments. Because of this, orthopaedic surgeons have worked to optimize postoperative pain management that provides the best relief. Opioids traditionally were the primary medication for pain control during the perioperative period, however, with the current opioid epidemic and opioids being the leading cause of accidental deaths in the United States, physicians have transitioned to multimodal pain control which has shown to provide better pain control. In cases involving knee arthroscopy, pain management options include variations of nerve blocks, medications, surgical techniques, and postoperative activity.

An anterolateral genicular nerve block has been proposed that focuses on decreasing postoperative pain in the lateral aspect of the knee by targeting the lateral retinacular nerve, the nerve to the vastus lateralis, and the articular branch of the nerve to the vastus intermedius. Adductor canal blocks and intraarticular injections are known methods of providing postoperative pain control, but due to their risks, they may be inappropriate for knee arthroscopy. An anterolateral geniculate nerve block targets sensory, terminal nerve fibers outside the joint capsule, theoretically avoiding the risks of large nerve irritation and chondrotoxicity. Postoperative portal injections are another form of analgesia provided after knee arthroscopy and have been demonstrated to be equally effective in controlling pain as intraarticular injections one hour postoperatively. Otherwise, portal injections in knee arthroscopy have not been extensively studied in the literature.

Patients will be sent home after surgery with a survey to be completed at 2, 4, 6, 12, 24, and 48 hours and 1 week. The survey will inquire about the period from the prior survey to the current survey and will evaluate pain via Visual Analog Score, opioid consumption, non-opioid medication use, sleep, and intervention complications. Patients will be called at 12 and 48 hours and 1 week as reminders to complete the survey.

Enrollment: 72 estimated patients

Sex: All

Ages: 19 to 89 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• skeletally mature patients with indications for knee arthroscopy

Exclusion criteria

• include patients with previous knee surgery on the operative side
• opioid use within six weeks before surgery that is deemed to be chronic or excessive
• gabapentin use within six weeks before surgery
• diagnosis of chronic pain, fibromyalgia, or other somatosensory disorder(s)
• history of radicular pain or neuropathy in the operative limb
• patients with cancer

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

---

72 participants in 3 patient groups

No Intervention

No Intervention group

Description:

Patients will receive no intervention

Nerve Block

Active Comparator group

Description:

Patients in the anterolateral geniculate nerve block group will receive 20 cc of 0.25% bupivacaine with epinephrine distributed evenly between two injection sites by an 18G or 21G long needle. After completion of knee arthroscopy, the first injection is targeted at 2 fingerbreadths superior to the superolateral aspect of the patella. The needle is inserted down to the femur, pulled back slightly, and the surrounding area is infiltrated with 10 cc of anesthetic. The second injection is targeted approximately 2 to 3 fingerbreadths laterally to the first injection and 2 to 3 fingerbreadths proximal to the lateral epicondyle in line with the lateral femur. Once again, the needle is inserted down until bone is encountered and then slightly retracted 1 to 2 mm before infiltration with the remaining 10 cc of anesthetic.

Treatment:

Procedure: Nerve Block

Portal Anesthesia

Active Comparator group

Description:

Patients in the portal anesthesia group will also receive 20 cc of 0.25% bupivacaine with epinephrine distributed evenly between portal sites. After completion of knee arthroscopy, portal tracts are closed and the knee is ensured to be evacuated of residual fluid. An 18G or 21G long needle is then used to infiltrate each portal tract where the anesthetic will be delivered.

Treatment:

Procedure: Portal Anesthesia