Osteoarthritis
Conditions
Keywords
femoral nerve block, adductor canal block, steroid, total knee replacement
Brief summary
We hypothesize continuous adductor canal block with steroid adjuvant would offer no inferior analgesics and rehabilitation ability than continuous femoral nerve block for postoperative patients receiving total knee arthroplasty.
Detailed description
A total of 80 patients who will undergo total knee arthroplasty will be randomized into two groups: Treatment groups Treatment details Femoral Group (40 patients) Continuous femoral nerve block (bolus: 0.5% Ropivacaine 10-15 ml ; infusion of 0.15 % Ropivacaine 4-6ml/h) Adductor Group (40 patients) Adductor canal block with steroid adjuvant (bolus: 0.5% Ropivacaine 10-15ml; Dexamethasone 4mg) (Total 80 patients will be recruited) * All patients will receive single shot tibial nerve block with local anaesthetics (0.5% Ropivacaine 5-8ml) before surgery for analgesia of posterior knee. * All patients will receive the same preemptive and postoperative multimodal medications for perioperative analgesia. * All groups will receive standardized method of spinal anaesthesia and standardized method of intraoperative sedation for the surgery. * Intravenous patient controlled analgesia (PCA) with morphine will be given for 48h to patient as rescue analgesia.
Interventions
PROCEDUREadductor canal block
Continuous adductor canal block and single shot posterior tibial nerve block under ultrasound guidance and using nerve stimulating needle (bolus: 0.5% Ropivacaine 10-15ml with dexamethasone 4mg ;with single shot posterior tibial nerve block (8-10ml 0.5% ropivacaine)
PROCEDUREfemoral nerve block
Femoral nerve catheter inserted under ultrasound guidance using nerve stimulating needle administering ropivacaine bolus 10-15ml and infusing 0.2% ropivacaine at 4-6ml/h; plus a single shot posterior tibial nerve block under ultrasound guidance and use of nerve stimulating needle
Sponsors
Queen Elizabeth Hospital, Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
30 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of primary osteoarthritis * Scheduled for elective total knee arthroplasty * Signed written informed consent * Planned use of spinal anaesthesia * Cognitive sound to use assessment tools
Exclusion criteria
* Patients refusing to give consents * Scheduled for revision total knee replacement * Patient outside range of 30 to 80 yrs old * Non-chinese population * Cognitive impairment/ inability to use the outcome assessment tools * Contraindications to regional anesthesia * severe cardiovascular disease (unstable angina, second or third degree heart block) * pre-existing neurologic disease including psychiatric disorder * drug abuser * Pre-operative history of neurological abnormality in the ipsilateral leg e.g. history of stroke, neurogenic pain or previous nerve injury. * Allergy or contraindication to drugs used in this study: morphine, Non-steroidal anti-inflammatory drugs (NSAID) such as ketorolac , diclofenac, dihydrocodeine, local anaesthetics (lignocaine, ropivacaine, bupivacaine), epinephrine * Moderate or severe renal impairment (serum creatinine \> 160 micromol/l)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PCA morphine or pain rescuer consumption at 24h and 48h postoperative | 24h and 48h postoperative | — |
| Postoperative pain score (visual analogue scale 0-10) at 6h,12h, 24h,48h, 72h after surgery | 6h,12h, 24h,48h, 72h after surgery | — |
| Quadriceps strength at 24h, 48h, 72h postoperative | 24h, 48h, 72h postoperative | using dynamometer (measure in Newton/centimeter square) |
Secondary
| Measure | Time frame |
|---|---|
| postoperative nausea or vomiting | 0-72h |
| Patient satisfaction score (0-4) | upon discharge |
| Haemastix on call and every 8 hours after surgery for postoperative 24hours for patients | on call and every 8 hours after surgery for postoperative 24h |
| postoperative pruritis | 0-72h |
| Length of Stay in hospital 6. Length of Stay in hospital length of hospital stay | upon discharge |
| Incidence of side effects and complications at postoperative day 0- 4 postoperative | postoperative period 0-96 hr postoperative |
Countries
Hong Kong
Contacts
Primary ContactEric So, FHKCA FHKAM
Outcome results
None listed