None listed
Conditions
Brief summary
We are studying how to optimise pain relief after knee joint operation. An adductor canal catheter (plastic tube placed near the nerve providing sensation to knee) is used to provide numbing medicine called local anaesthesia for pain relief after a knee joint replacement. We are looking at comparing a continuous drip of local anaesthesia versus intermittent delivery of a larger volume of local anaesthesia called a Programmed intermittent bolus (PIB). We will measure the participants satisfaction, overall use of painkillers and how well they can participate in rehabilitation. We will use the findings of this study to help us optimise our pathways for future patients having their knee replacement operation.
Interventions
Patients undergoing Total Knee Arthroplasty will be randomly assigned to one of two groups in a double-blinded manner. They will all receive the established pain relief treatment (Adductor Canal Catheter - a peripheral nerve catheter) and have 0.2% ropivacaine as the local anaesthetic.
1. Group 1 - Continuous infusion of local anaesthesia at 5mls/hr of 0.2% ropivacaine (10mg/hr)
2. Group 2 - Programmed intermittent bolus of local anaesthesia - 10mls every 2 hours of 0.2% ropivacaine. (20mg eve
Patients undergoing Total Knee Arthroplasty will be randomly assigned to one of two groups in a double-blinded manner. They will all receive the established pain relief treatment (Adductor Canal Catheter - a peripheral nerve catheter) and have 0.2% ropivacaine as the local anaesthetic. 1. Group 1 - Continuous infusion of local anaesthesia at 5mls/hr of 0.2% ropivacaine (10mg/hr) 2. Group 2 - Programmed intermittent bolus of local anaesthesia - 10mls every 2 hours of 0.2% ropivacaine. (20mg every 2 hours) The infusion will start in the postoperative anaesthetic care unit (PACU) and continue for 48 hours after the start of the study drug/method of delivery. We will follow up at least once daily for 72 hours after commencing study infusion, we will check adherence to study protocol and document any violations or deviation from prescribed methods; audit of hospital records, medication charts and participant's responses will be used to monitor adherence to study protocol.
Sponsors
Counties Manukau Health, Middlemore Hospital Research Office
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
We aim to enrol patients undergoing primary TKA in our institution prior to the day of surgery in the preadmission clinic or on the day of surgery at the time of surgical and anaesthetic consent. Adequate time for patient questions and a plain language explanation sheet will be provided to aid patient consent. The study will be completed at Middlemore Hospital and Manukau Surgical Centre.
Exclusion criteria
•Refusal or inability to consent. •Analgesic technique involving epidural or peripheral nerve blockade (single shot or continuous techniques) •Nerve catheter placed outside accepted range (distal to femoral triangle down to the adductor canal) •Allergies to medication used in the study or its constituents •Significant kidney and liver dysfunction (CrCl < 30mls/min, AST/ALT >2x upper limit of normal) •Surgical procedure performed outside of Counties Manukau Health facilities. •Failure to site adductor canal catheter in the appropriate location. •Patients on >30mg/day of oral morphine equivalent for any reason. •Patients outside the specified age range of 18-80 years. •Patients at extremes of weight e.g.<50kg or >150kg •If surgical team do not wish to take part or give individually tailored treatment that violate study protocol.
Outcome results
None listed