Analgesia in Total Knee Arthroplasty
Conditions
Brief summary
Total knee arthroplasty or replacement (TKA), a commonly performed surgery for osteoarthritis of the knee, is a painful procedure and requires a multimodal analgesic approach. A method for analgesia is local infiltration analgesia (LIA), where a mixture of drugs is injected around the knee joint. Adductor canal block (ACB) is an alternative regional anaesthesia technique which has been shown to result in minimal thigh weakness. The investigators aim to study if the analgesia provided by ACB is superior to LIA while preserving quadriceps strength.
Interventions
PROCEDUREAdductor Canal Block
Sponsors
Changi General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
45 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for primary TKA under single shot spinal anaesthesia, between ages 45-85 years old, American Society of Anesthesiologists (ASA) physical status 1 to 3 and BMI 18-35 kg/m2
Exclusion criteria
* Patients unable to give consent, inability to communicate/ cooperate, patients with regular consumption of strong opioids (morphine, oxycodone) or steroids, allergy to local anaesthetics or any drugs included in the study, patients with lower limb surgery in the preceding year, patients with pre-existing neurological deficits and patients who have contraindications for spinal anaesthesia.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption in the first 24 hours | 24 hours | morphine consumption in the first 24 hours (including morphine administered in recovery and via PCA). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain Scores | 1, 6, 12, 24 hours; up to 48 hours postoperative | Pain scores are recorded at 1, 6, 12, 24 and 48 hours post-operatively, assessed using a visual analog scale (0-100mm) at rest and during 45 degree passive flexion of knee. |
| Morphine Consumption | At 48 hours | The balance usage after primary outcome |
| Postoperative Nausea and Vomiting | Up to 48 hours | Presence/absence of nausea and vomiting, and total number of episodes of vomiting |
| Sedation Scores | Up to 48 hours | — |
| Quadriceps Strength | at 24 and 48 hours | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Presence of Complications | up to 48 hours | Hematoma, wound infection, neurological deficits, any incidence of fall |
| Length of Hospital Stay | Up to 30 days | Number of days till discharge |
Countries
Singapore
Outcome results
None listed