Pre vs Post Block in Total Knee Arthroplasty (TKA)

University of Miami

Status and phase: Completed; Phase 4

Conditions: Postoperative Pain; Arthroplasty Complications; Knee Osteoarthritis

Treatments: Drug: Oxycodone; Drug: Meloxicam; Drug: Lyrica; Drug: Ropivacaine; Drug: Celebrex; Drug: Acetaminophen; Drug: Dexamethasone

Study type: Interventional

Funder types: Other

Identifiers

NCT05974501

20230147

Details and patient eligibility

About

The purpose of this project is to determine if a change in patient reported pain, nausea and vomiting after total knee arthroplasty can be observed with the substitution of a post operative adductor canal block for a preoperative adductor canal block in the current established peri-operative pain protocol and if these changes lead to a decrease in opioid consumption (in morphine equivalents).

Enrollment: 84 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1- Patients 18 or older 2 - Patients undergoing primary total knee replacement at the University of Miami Hospital 3 - Patients that have capacity to provide medical consent

Exclusion criteria

1. All patients under the age of 18
2. Prisoners, uncontrolled diabetics, increased risk of bleeding, pregnant women, women planning on becoming pregnant in the next year, and women who think they might be pregnant.
3. Patients with prior surgery or history of infection on the joint of interest.
4. Patients on steroid preoperatively.
5. Inability to provide medical consent.
6. Patients with a history of significant unmitigated pain in parts of their body not including the knee the procedure is to be performed or a history of pain catastrophizing (the tendency to magnify the threat value of the pain stimulus and to feel helpless in the context of pain, and by a relative inability to inhibit pain-related thoughts in anticipation of, during or following a painful event) regarding pain anywhere in the body.
7. Any condition that, in the opinion of the investigator, would compromise the well-being of the patient or the study or prevent the patient from meeting or performing study requirements will exclude the participant.
8. Allergy to local anesthetic or any medication used in the standard protocol for joint replacement.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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84 participants in 2 patient groups

Preoperative Adductor Canal Block Group

Active Comparator group

Description:

Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery.

Treatment:

Drug: Dexamethasone

Drug: Celebrex

Drug: Acetaminophen

Drug: Ropivacaine

Drug: Lyrica

Drug: Oxycodone

Drug: Meloxicam

Postoperative Adductor Canal Block Group

Experimental group

Description:

Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours

Treatment:

Drug: Dexamethasone

Drug: Celebrex

Drug: Acetaminophen

Drug: Ropivacaine

Drug: Lyrica

Drug: Oxycodone

Drug: Meloxicam