Trial Evaluating Postop Pain and Muscle Strength Among Regional Anesthesia Techniques for Ambulatory ACL Reconstruction

Vanderbilt University Medical Center

Status: Completed

Conditions: Tear of Anterior Cruciate Ligament; Rupture of Anterior Cruciate Ligament

Treatments: Procedure: adductor canal continuous nerve catheter; Drug: Normal Saline as bolus followed by bupivacaine; Procedure: adductor canal nerve block; Drug: Fentanyl; Drug: ropivacaine and dexamethasone; Drug: Propofol; Drug: Mepivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT02584452

151095

Details and patient eligibility

About

Despite the apparent multifaceted benefit in differentiating blockade sites and duration of nerve blockade, the efficacy of continuous adductor canal blockade utilized specifically in ACL reconstruction has not been extensively studied. This study will test the hypothesis that the use of the adductor canal continuous nerve catheter will result in lower subjective pain scores on postoperative day 2 and improved quadriceps strength on postoperative day 1.

Full description

Study participants will be randomized to 2 groups: (1) continuous adductor canal nerve catheter or (2) long-acting single bolus adductor canal nerve block.

Following random selection via random envelope selection patients will receive the following procedures. Both groups will receive ultrasound guided femoral nerve block with 20cc of 2% mepivacaine <20 minutes prior to in room time.

Intraoperative care will consist of general anesthesia under the care of the attending anesthesiologist assigned to the patient. Induction will include a propofol bolus and placement of laryngeal mask airway. Intraoperative opioid should be limited to no more than 150mcg of fentanyl. Upon completion of wound closure, appropriate dressing placement, emergence from anesthesia and removal of LMA, patients to be taken to PACU. Once adequately awake and alert, Group 1 patients 1 will receive ultrasound guided adductor canal continuous nerve catheter using normal saline as bolus for placement, followed by initiation of 1/8% bupivacaine infusion through catheter at 8cc/h. Group 2 will receive ultrasound guided adductor canal nerve block with 10cc of 0.5% ropivacaine + 2mg dexamethasone (0. 5cc), keeping total injectate at 10.5cc to spare significant proximal spread to femoral nerve14. After adequate instruction including catheter education (if applicable) patients are to be discharged home.

Enrollment: 59 patients

Sex: All

Ages: 14+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 14 and older
• Patients who are scheduled to undergo an ACL reconstruction with patella or allograft
• Patient does not have a contraindication to receiving regional anesthesia

Exclusion criteria

• Allergy to local anesthetics, dexamethasone, or adhesive tape
• Patients undergoing hamstring graft for ACL
• Preexisting infection at site of needle insertion
• Immunocompromised patients
• Preexisting sensory or motor deficit in operative extremity
• Patient on chronic opioid treatment.
• Patient having a revision of previous ACL reconstruction.
• Pregnancy and lactating women

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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59 participants in 2 patient groups

Continuous Adductor Canal Nerve Catheter

Active Comparator group

Description:

Ultrasound guided femoral nerve block with 20cc of 2% mepivacaine \<20 minutes prior to in room time. Intraoperative patients will undergo initiation of general anesthesia under the care of the attending anesthesiologist assigned to the patient. Induction will include a propofol bolus and placement of laryngeal mask airway. Intraoperative opioid should be limited to no more than 150mcg of fentanyl. Upon completion of wound closure, appropriate dressing placement, emergence from anesthesia and removal of LMA, patients to be taken to PACU. Once adequately awake and alert this group will receive ultrasound guided adductor canal continuous nerve catheter using normal saline bolus followed by 1/8% bupivacaine infusion through catheter at 8cc/h.

Treatment:

Drug: Propofol

Procedure: adductor canal continuous nerve catheter

Drug: Fentanyl

Drug: Normal Saline as bolus followed by bupivacaine

Drug: Mepivacaine

Long Acting Single Bolus Adductor Canal Nerve Block

Active Comparator group

Description:

Ultrasound guided femoral nerve block with 20cc of 2% mepivacaine \<20 minutes prior to in room time. Intraoperative patients will undergo initiation of general anesthesia under the care of the attending anesthesiologist assigned to the patient. Induction will include a propofol bolus and placement of laryngeal mask airway. Intraoperative opioid should be limited to no more than 150mcg of fentanyl. Upon completion of wound closure, appropriate dressing placement, emergence from anesthesia and removal of LMA, patients to be taken to PACU. Once adequately awake and alert this group will receive ultrasound guided adductor canal nerve block with 10cc of 0.5% ropivacaine and 2 mg dexamethasone (0. 5cc), keeping total injectate at 10.5cc to spare significant proximal spread to femoral nerve.

Treatment:

Drug: Propofol

Drug: ropivacaine and dexamethasone

Drug: Fentanyl

Procedure: adductor canal nerve block

Drug: Mepivacaine