Epidural Analgesia vs Adductor Canal Block in Bilateral TKA

Overview

This study evaluates postoperative analgesic efficacy within 48 hours between epidural analgesia and single-shot bilateral adductor canal blocks in bilateral total knee arthroplasty. Half of participants will be received continuous epidural analgesia, while other half of participants will be received single-shot bilateral adductor canal blocks.

Full Title of Study: “Comparison Efficacy of Analgesic Techniques: Continuous Epidural Analgesia Versus Bilateral Single-shot Adductor Canal Blocks in Patients Undergoing Bilateral Total Knee Arthroplasty”

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: June 30, 2021

Detailed Description

Continuous epidural analgesia is effective postoperative pain control but it has some limitations in patients with hypotension, concurrent anticoagulants, technical difficulty, urinary retention. Adductor canal block is less invasive than continuous epidural analgesia. It provides effective analgesia for total knee arthroplasty and preserves quadriceps muscle strength.

Interventions

  • Procedure: Continuous epidural block
    • Continuous epidural block at level L2-3 or L3-4 with 0.0625% bupivacaine + fentanyl 2 mcg/ml infusion epidurally 5 ml/hr for 48 hours postoperatively.
  • Procedure: Bilateral single-shot bilateral adductor canal blocks
    • Bilateral single-shot adductor canal blocks, ultrasound guidance, with 0.33% bupivacaine 15 ml on each side.

Arms, Groups and Cohorts

  • Experimental: Epidural analgesia
    • Lumbar continuous epidural block
  • Experimental: Bilateral ACB
    • Ultrasound-guided bilateral adductor canal blocks

Clinical Trial Outcome Measures

Primary Measures

  • pain scores at rests
    • Time Frame: 48 hours postoperatively
    • numerical rating scales

Secondary Measures

  • morphine consumptions
    • Time Frame: 48 hours postoperatively
    • total miligrams of morphine use in each arm
  • pain scores on movement
    • Time Frame: 48 hours postoperatively
    • numerical rating scales
  • side effects of interventions
    • Time Frame: 48 hours postoperatively
    • nausea vomiting hypotension

Participating in This Clinical Trial

Inclusion Criteria

  • Aged more than 18 years old undergoing bilateral total knee arthroplasty – American Society of Anesthesiologists physical status classification 1-3 Exclusion Criteria:

  • Participants deny to enroll the study – Allergy to bupivacaine – Weight less than 50 kilograms – Hepatic disease – Contraincation for neuraxial block or adductor canal block – Uncontrolled cardiovascular disease – Creatinine clearance less than 50 ml/min

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Mahidol University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Suwimon Tangwiwat, Assistant professor, Anesthesiology department, Faculty of Medicine Siriraj Hospital – Mahidol University
  • Overall Official(s)
    • Suwimon Tangwiwat, MD, Principal Investigator, Faculty of Medicine Siriraj Hospital
  • Overall Contact(s)
    • Suwimon Tangwiway, +6624197000, stangwiwat@yahoo.com

References

Dimitris CN, Taylor BC, Mowbray JG, Steensen RN, Gaines ST. Perioperative morbidity and mortality of 2-team simultaneous bilateral total knee arthroplasty. Orthopedics. 2011 Dec 6;34(12):e841-6. doi: 10.3928/01477447-20111021-02.

Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev. 2003;(3):CD003071. Review.

Jenstrup MT, Jæger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O, Larsen TK, Dahl JB. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand. 2012 Mar;56(3):357-64. doi: 10.1111/j.1399-6576.2011.02621.x. Epub 2012 Jan 4.

Gerrard AD, Brooks B, Asaad P, Hajibandeh S, Hajibandeh S. Meta-analysis of epidural analgesia versus peripheral nerve blockade after total knee joint replacement. Eur J Orthop Surg Traumatol. 2017 Jan;27(1):61-72. doi: 10.1007/s00590-016-1846-z. Epub 2016 Sep 3. Review.

Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008 Feb;100(2):154-64. doi: 10.1093/bja/aem373. Review.

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