Pain Control for Anterior Cruciate Ligament Reconstruction Patients With Adductor Canal or Femoral Perineural Infusions

Stanford University

Status: Completed

Conditions: Anterior Cruciate Ligament Injury; Pain, Postoperative

Treatments: Device: Nimbus pump (Infutronix); Procedure: Adductor Canal perineural catheter placement; Procedure: Femoral Nerve perineural catheter placement

Study type: Interventional

Funder types: Other

Identifiers

NCT03208478

41970

Details and patient eligibility

About

Nerve blocks are used to provide pain control after moderately painful orthopedic surgeries. Anterior Cruciate Ligament (ACL) reconstruction with patellar autograft is a painful orthopedic procedure performed after traumatic injury to the knee. Many patients undergoing ACL reconstruction receive a nerve block as part of their anesthetic care. These blocks can be performed in different locations along the femoral nerve, with advantages and disadvantages to each location. Recently published evidence indicates that there is no short-term difference in pain control between the two commonly-targeted locations ("Adductor Canal" and "Femoral"). However, studies involving patients undergoing total knee arthroplasty indicate that femoral blocks provide better pain control with movement than adductor canal blocks. As many patients undergoing ACL reconstruction use continuous passive motion (CPM) machines as part of rehabilitation starting on post-operative day one, the investigators hypothesize that pain control and quality of recovery in the first 48 hours after surgery will be superior with a continuous femoral block than with a continuous adductor canal block. The investigators plan to study this by randomizing patients presenting for ACL reconstruction to receive either a continuous femoral or continuous adductor canal block (both considered adequate means of pain control), and following them to 48 hours to determine the level of pain, quality of recovery score, opioid use, and CPM compliance.

Full description

covery score, opioid use, and CPM compliance.

Enrollment: 60 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult patients >18 years
• ASA physical status I, II, or III
• Scheduled for ACL reconstruction surgery with patellar autograft

Exclusion criteria

• Pregnancy
• Incarceration
• Age <18
• BMI >35
• Pre-operative opioid use >15 mg morphine equivalents per day
• Inability to communicate with investigators by telephone
• Pre-existing neuropathy of the operative extremity

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups

Adductor Canal Nerve Block group

Active Comparator group

Description:

Adductor Canal perineural catheter placement. Adductor Canal continuous perineural infusion. Ropivacaine 0.2% will be administered at a continuous rate of 5 mL/hour through a perineural catheter placed in the adductor canal. A Nimbus pump (Infutronix) will be delivering the medication.

Treatment:

Device: Nimbus pump (Infutronix)

Procedure: Adductor Canal perineural catheter placement

Femoral Nerve Block group

Active Comparator group

Description:

Femoral Nerve perineural catheter placement. Femoral continuous perineural infusion. Ropivacaine 0.2% will be administered at a continuous rate of 5 mL/hour through a perineural catheter placed near the femoral nerve. A Nimbus pump (Infutronix) will be delivering the medication.

Treatment:

Procedure: Femoral Nerve perineural catheter placement

Device: Nimbus pump (Infutronix)