Does Single Injection Adductor Canal Block Improve Postoperative Analgesia in Patients Receiving Periarticular Local Anesthesia Injections for Total Knee Arthroplasty?

Overview

The purpose of the study is to determine the effect of a single injection adductor canal block (ACB) on pain scores within 24 hours post total knee arthroplasty (TKA).

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Factorial Assignment
    • Primary Purpose: Supportive Care
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: July 2022

Interventions

  • Other: ACB Control – 20 ml saline injection for ACB
    • Adductor Canal Block Control (20 ml saline injection)
  • Drug: ACB Study – 20 ml 0.5% Ropivacaine for Adductor Canal Block
    • Adductor Canal Block Study (20 ml 0.5% Ropivacaine)
  • Drug: Local infiltration – 100 mLs of a solution containing: Ropivacaine + Epinephrine + Ketorolac + Clonidine + 0.9% Normal saline
    • 100 mLs of a solution containing: Ropivacaine 2 mg/mL (49.25 mL) + Epinephrine 1 mg/mL (0.5 mL) + Ketorolac 30mg/mL (1mL) + Clonidine 100 mcg/mL (0.8 mL) + 0.9% Normal saline (48.45 mL)

Arms, Groups and Cohorts

  • Experimental: ACB Control + Local Infiltration
    • ACB Control – 20 ml saline injection for ACB + Local infiltration – 100 mLs of a solution containing: Ropivacaine + Epinephrine + Ketorolac + Clonidine + 0.9% Normal saline
  • Experimental: ACB Study + Local infiltration
    • ACB Study – 20 ml 0.5% Ropivacaine for Adductor Canal Block + Local infiltration – 100 mLs of a solution containing: Ropivacaine + Epinephrine + Ketorolac + Clonidine + 0.9% Normal saline
  • Experimental: ACB Study Only
    • ACB Study – 20 ml 0.5% Ropivacaine for Adductor Canal Block

Clinical Trial Outcome Measures

Primary Measures

  • Pain Score
    • Time Frame: within 24 hours postoperative
    • The primary outcome variable of interest is the average maximum pain score within 24 hours postoperative.

Secondary Measures

  • Opioid Use
    • Time Frame: within 24 hours postoperative
    • 24 Hour post-surgical opioid use
  • PACU Opioid Use
    • Time Frame: Postoperative (while in PACU), an expected average of 60 minutes
    • PACU opioid use
  • Daily Opioid Use
    • Time Frame: duration of hospital stay, an expected average of 3 days
    • Average daily opioid use during hospitalization
  • Average NRS Pain Score
    • Time Frame: within 24 hours postoperative
    • Average NRS pain score
  • Length of Stay
    • Time Frame: duration of hospital stay, an expected average of 3 days
    • Length of hospital stay

Participating in This Clinical Trial

Inclusion Criteria

  • Males and Females age 18+ years old having total knee arthroplasty (TKA) at UCI Medical Center – American Society of Anesthesiologists physical status I to III Exclusion Criteria:

  • Allergy to local anesthetics – Pregnancy – Nursing Mothers – Children <18 years of age – Renal impairment (GFR<60 mL/min/1.73m2) – Hepatic Impairment (active hepatitis, elevated AST or ALT, jaundice) – Opioid tolerant patients (defined as greater than 30 mg Morphine equivalent consumed daily) – Patients that are diabetic with peripheral neuropathy – BMI greater than 40

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of California, Irvine
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Coral Sun, MD, Principal Investigator, University of California, Irvine
  • Overall Contact(s)
    • Coral Sun, MD, (714) 456-5501

References

Wylde V, Rooker J, Halliday L, Blom A. Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res. 2011 Apr;97(2):139-44. doi: 10.1016/j.otsr.2010.12.003. Epub 2011 Mar 8.

Robbins SM, Rastogi R, McLaughlin T-L. Predicting Acute Recovery of Physical Function Following Total Knee Joint Arthroplasty. J. Arthroplasty. 2013. Available at: http://www.sciencedirect.com/science/article/pii/S088354031300466X. Accessed December 17, 2013.

Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006 May 13;367(9522):1618-25. Review.

Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009 Oct;22(5):588-93. doi: 10.1097/ACO.0b013e328330373a. Review.

Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, Murthy Y. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010 Nov;113(5):1144-62. doi: 10.1097/ALN.0b013e3181f4b18. Review.

Feibel RJ, Dervin GF, Kim PR, Beaulé PE. Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty. 2009 Sep;24(6 Suppl):132-7. doi: 10.1016/j.arth.2009.04.008. Epub 2009 Jun 24.

Jæger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med. 2013 Nov-Dec;38(6):526-32. doi: 10.1097/AAP.0000000000000015.

Mudumbai SC, Kim TE, Howard SK, Workman JJ, Giori N, Woolson S, Ganaway T, King R, Mariano ER. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res. 2014 May;472(5):1377-83. doi: 10.1007/s11999-013-3197-y.

Ng FY, Ng JK, Chiu KY, Yan CH, Chan CW. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: a prospective, crossover, randomized clinical trial. J Arthroplasty. 2012 Jun;27(6):1234-8. doi: 10.1016/j.arth.2011.12.021. Epub 2012 Feb 8.

Teng Y, Jiang J, Chen S, Zhao L, Cui Z, Khan MS, Du W, Gao X, Wang J, Xia Y. Periarticular multimodal drug injection in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014 Aug;22(8):1949-57. doi: 10.1007/s00167-013-2566-0. Epub 2013 Jun 20. Review.

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