Total Knee Arthroplasty Utilizing Adductor Canal Block: Effect on Quadriceps Sparing

Hospital for Special Surgery (HSS)

Status: Terminated

Conditions: Osteoarthritis (Knee)

Treatments: Procedure: Low Volume Adductor Canal Block; Procedure: Femoral Nerve Block; Procedure: High Volume Adductor Canal Block

Study type: Interventional

Funder types: Other

Identifiers

NCT02081911

IRB #2014-005

Details and patient eligibility

About

The purpose of this study is to investigate whether there is quantitative motor-sparing of the quadriceps muscles following adductor canal nerve block versus femoral nerve block. Patients will be randomly placed into one of three treatment groups: 1) Femoral nerve block, 2) Adductor canal nerve block - low volume, or 3) Adductor canal nerve block - high volume. Quadriceps function will be assessed in the operating room using a skin patch and electrical stimulation. Follow up visits with the patients will continue over the course of 2 days during patient's stay at the hospital. A total of 60 patients will be enrolled for the study.

Enrollment: 33 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All patients undergoing primary unilateral total knee arthroplasty
• Planned use of combined spinal epidural (CSE) anesthesia
• Ability to follow study protocol

Exclusion criteria

• Contraindication to a spinal or epidural anesthetic
• Chronic opioid use (defined as daily or almost daily use of opioids for >3 months)
• Allergy to local anesthetics
• Pre-existing neuropathy or weakness of the operative limb
• Any neuromuscular disorder
• Diabetes type I and II
• Contraindication to a femoral nerve block or adductor canal nerve block
• Allergy or intolerance to any of the study medications
• BMI > 35 kg/m2

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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33 participants in 3 patient groups

High volume Adductor canal block

Experimental group

Description:

Adductor canal block performed in the distal thigh (1/3 of the total distance between the superior border of the patella and the femoral crease, cephalad to the patella) utilizing an injectate volume of 30 mL 0.25% bupivacaine/ epinephrine

Treatment:

Procedure: High Volume Adductor Canal Block

Low volume Adductor Canal Block

Experimental group

Description:

Adductor canal block performed in the distal thigh (1/3 of the total distance between the superior border of the patella and the femoral crease, cephalad to the patella) utilizing an injectate volume of of 10 mL 0.75% bupivacaine/ epinephrine

Treatment:

Procedure: Low Volume Adductor Canal Block

Femoral nerve block

Experimental group

Description:

Femoral nerve block with 10 mL 0.75 % bupivacaine/epinephrine

Treatment:

Procedure: Femoral Nerve Block