A Randomised Controlled Trial Comparing Single Shot Adductor Canal Block With Local Infiltration Analgesia for Postoperative Analgesia After Total Knee Arthroplasty

Overview

Total knee arthroplasty or replacement (TKA), a commonly performed surgery for osteoarthritis of the knee, is a painful procedure and requires a multimodal analgesic approach. A method for analgesia is local infiltration analgesia (LIA), where a mixture of drugs is injected around the knee joint. Adductor canal block (ACB) is an alternative regional anaesthesia technique which has been shown to result in minimal thigh weakness. The investigators aim to study if the analgesia provided by ACB is superior to LIA while preserving quadriceps strength.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Outcomes Assessor)
  • Study Primary Completion Date: December 2015

Interventions

  • Procedure: Adductor Canal Block

Arms, Groups and Cohorts

  • No Intervention: Local Infiltration Analgesia
    • The Local Infiltration Analgesia group will receive local infiltration of ropivacaine 150mg, ketorolac 30mg, morphine 10mg, adrenaline 200mcg and vancomycin 500mg in a total volume of 75mls by the surgeon.
  • Active Comparator: Adductor Canal Block
    • The Adductor Canal Block group of patients will receive intravenous ketorolac 30mg intra-operatively and an adductor canal block at the end of surgery. The block will be performed under real time ultrasound guidance and 30mls of 0.5% ropivacaine (150mg) is injected with a Stimuplex A100, 21G needle.

Clinical Trial Outcome Measures

Primary Measures

  • Morphine consumption in the first 24 hours
    • Time Frame: 24 hours
    • morphine consumption in the first 24 hours (including morphine administered in recovery and via PCA).

Secondary Measures

  • Pain Scores
    • Time Frame: 1, 6, 12, 24 hours; up to 48 hours postoperative
    • Pain scores are recorded at 1, 6, 12, 24 and 48 hours post-operatively, assessed using a visual analog scale (0-100mm) at rest and during 45 degree passive flexion of knee.
  • Morphine Consumption
    • Time Frame: At 48 hours
    • The balance usage after primary outcome
  • Postoperative Nausea and Vomiting
    • Time Frame: Up to 48 hours
    • Presence/absence of nausea and vomiting, and total number of episodes of vomiting
  • Sedation Scores
    • Time Frame: Up to 48 hours
  • Quadriceps Strength
    • Time Frame: at 24 and 48 hours

Participating in This Clinical Trial

Inclusion Criteria

  • Patients scheduled for primary TKA under single shot spinal anaesthesia, between ages 45-85 years old, American Society of Anesthesiologists (ASA) physical status 1 to 3 and BMI 18-35 kg/m2 Exclusion Criteria:

  • Patients unable to give consent, inability to communicate/ cooperate, patients with regular consumption of strong opioids (morphine, oxycodone) or steroids, allergy to local anaesthetics or any drugs included in the study, patients with lower limb surgery in the preceding year, patients with pre-existing neurological deficits and patients who have contraindications for spinal anaesthesia.

Gender Eligibility: All

Minimum Age: 45 Years

Maximum Age: 85 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Changi General Hospital
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Yean Chin Lim, MBBS, Principal Investigator, Changi General Hospital

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