Knee Arthroplasty
Conditions
Keywords
continuous femoral nerve blockade, knee arthroplasty, knee replacement, regional anesthesia, readiness to discharge, Femoral nerve blockade for total knee arthroplasty
Brief summary
Patients undergoing total knee arthroscopy (knee replacement) surgery usually receive a femoral nerve block as part of their anesthetic care. Some centers administer the block with a single shot of local anesthetic, which wears off several hours after surgery. Other centers administer the block with a single shot followed by continuous infusion of local anesthetic, typically for 2 to 5 days after surgery. The latter method, though good for pain control, may result in decreased mobility (while the anesthetic is still active), longer hospital stays, and greater risk of falls. This study will see if using a lower concentration of local anesthetic for the continuous femoral nerve block or only the initial single-shot dose will result in increased mobility and shorter hospital stays.
Interventions
DRUGBolus of 0.2% ropivicaine 20 mls followed by 0.2% ropivicaine at an infusion rate of 5mls/hr until 0600 on postoperative day 2
Initial bolus of 0.2% ropivicaine 20 mls into the femoral catheter followed by 0.2% ropivicaine at an infusion rate of 5mls/hr with patient controlled boluses of 5ml available every 30 mins, until 0600 on the morning of postoperative day 2
DRUGBolus of 0.2% ropivicaine 20 mls followed by 0.1% ropivicaine at an infusion rate of 10mls/hr until 0600 on post-operative day 2
Initial bolus of 0.2% ropivicaine 20 mls into the femoral catheter followed by 0.1% ropivicaine at an infusion rate of 10mls/hr with patient controlled boluses of 10mls available every 30 mins, until 0600 on the morning of postoperative day 2
DRUGSaline control
Bolus of 0.375% ropivicaine 30 mls followed by saline infusion until 0600 on postoperative day 2
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. ASA physical status I-III 2. 18-85 years of age, inclusive 3. Able to communicate in English sufficiently to participate in the study 4. Able to walk 30 metres without stopping prior to surgery
Exclusion criteria
1. Intended discharge to in-patient rehabilitation facility 2. Patient refusal of FNB or spinal anesthetic or sciatic nerve block 3. Contraindications to peripheral nerve block (e.g. allergy to local anesthetics, refusal) 4. Significant peripheral neuropathy or neurological disorder affecting the lower extremity 5. Contraindication to a component of multi-modal analgesia 6. Pregnancy 7. History of use of over 30mg oxycodone or equivalent per day (institutional threshold for acute pain service consultation pre-operatively) 8. History of significant cognitive or psychiatric condition that may affect patient assessment 9. Inability to provide informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Time to readiness to discharge from hospital | Twice daily until discharge |
Secondary
| Measure | Time frame |
|---|---|
| Quadriceps strength, knee flexion, walking distance, pain, patient satisfaction, opioid consumption, adverse events, incidence of falls, volume of local anesthetic administered, block success, discharge date, functional recovery | Up to Month 6 post-operative |
Countries
Canada
Outcome results
None listed