None listed
Conditions
Brief summary
We are testing the hypothesis that Adductor Canal Catheters (ACC) have better quadriceps muscle sparing than Femoral Triangle Catheters (FTC), when used for post-operative analgesia in primary, unilateral total knee replacement surgery. Mobilisation is a key functional outcome after TKR. Ability to participate in physical therapy exercise is an important component of post-operative rehabilitation. This study will investigate if the anatomical location of the catheter used for analgesia impacts on mobilisation and analgesia, as this has recently been raised as a potential point of difference. If the study shows that mobilisation is superior or unchanged for a true adductor canal catheter placement, and analgesia is improved, it casts doubt on the applicability of previous studies. The clinical significance would be that anaesthetists should change the anatomical location for performance of this technique. If the study shows that mobilisation is not different, but analgesia is inferior for the adductor canal catheters, the significance is that while these compartments may be distinct on an anatomical basis, it is not clinically relevant. Anaesthetists can perform the current technique without concern about the theoretical differences raised between the anatomy of the ACC and FTC block.
Interventions
A Continuous femoral triangle block will be undertaken. An experienced regional anaesthetist will perform this procedure in the operating theatre immediately following the total knee replacement surgery. This is a single procedure, undertaken under local anaesthesia, where a small catheter is positioned under ultrasound guidance to lie adjacent to the femoral nerve branches in the mid-thigh (the level of the femoral triangle is identified by visualisation of the anatomical relationships of the
A Continuous femoral triangle block will be undertaken. An experienced regional anaesthetist will perform this procedure in the operating theatre immediately following the total knee replacement surgery. This is a single procedure, undertaken under local anaesthesia, where a small catheter is positioned under ultrasound guidance to lie adjacent to the femoral nerve branches in the mid-thigh (the level of the femoral triangle is identified by visualisation of the anatomical relationships of the thigh muscles - 5cm PROXIMAL to where the medial border of adductor longus muscle crossed the medial border of the sartorius muscle) . This catheter will be attached to a local anaesthetic pain pump for ongoing administration of local anaesthetic in the days following the procedure - 0.5% ropivacaine at 6mL per hour via an ambulatory AmbIT pump (Admedus Australia) for 3 days. All patients will undertake written informed consent before the procedure, including receiving written patient information.
Sponsors
Royal Princa Alfred Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults, aged > 18 years old, not pregnant Admitted for elective, primary, unilateral, total knee replacement Mentally competent to provide informed own written consent in English
Exclusion criteria
1. Previous total knee replacement surgery to same knee 2. Bilateral knee replacement surgery 3. previously enrolled in study 4. Chronic opioid use; defined as > 20mg oral morphine equivalent per day on average, in the 4 weeks prior to surgery
Outcome results
None listed