Total Knee Replacement
Conditions
Keywords
total knee arthroplasty, total knee replacement, local infiltration analgesia, intra-articular local anaesthesia, patients undergoing total knee arthroplasty (total knee replacement)
Brief summary
Total knee replacement (TKR) is associated postoperatively with considerable pain and analgesic requirement. Total knee replacement is routinely performed under spinal anaesthesia with intrathecal bupivacaine plus preservative free morphine. We hypothesize that infiltration of the surgical site with peri- and intraarticular levobupivacaine local anaesthetic would be an efficacious pain management technique and would not be inferior to intrathecal morphine for postoperative pain management. We further hypothesize that the use of this surgical site infiltration technique would decrease post-operative systemic opioid requirements as well as the side effects associated with intrathecal and systemic opioids.
Interventions
DRUGLevobupivacaine
Patients will receive peri- and intraarticular surgical site infiltration to the knee during surgery and before wound closure with a solution of levobupivacaine 0.5% 2mg/kg body weight (maximum 200mg levobupivacaine will be used if the patient's weight exceeds 100kg) plus 0.5mg epinephrine made up to 100ml with saline. An intra-articular catheter will be placed by the surgeon before closure under the sterile surgical conditions and this will be left in situ in the wound. The patient will receive one further injection of 15ml of levobupivacaine 0.5% solution at 8am on the morning of the first postoperative day after which the catheter will be removed.
DRUGIntrathecal morphine
Patients will receive spinal anaesthesia with intrathecal bupivacaine 0.5% (17.5 mg if greater than 70 kg and 15 mg if less than 70 kg) and preservative-free morphine (0.3 mg).
Sponsors
Cork University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for unilateral total knee replacement * Consent to spinal anaesthesia * ASA Grade I to III
Exclusion criteria
* Patient refusal * Mini-Mental Score \< 25 (see appendix 3) * Allergy to bupivacaine, morphine, paracetamol, diclofenac * Skin lesions/infection at site of injection * Uncorrected renal dysfunction * Coagulation disorders * chronic pain condition other than knee pain
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Quality of analgesia in the postoperative period as assessed by visual analogue score (VAS) for pain at rest and on movement | 24 hours postoperatively |
Secondary
| Measure | Time frame |
|---|---|
| Opioid consumption in total in the first 48 hours postoperatively | 48 hours postoperatively |
Countries
Ireland
Contacts
Primary ContactDenise M McCarthy, MB FCARCSI
Backup ContactGabriella Iohom, MB PhD
Outcome results
None listed