Total Knee Replacement
Conditions
Keywords
Anaesthetic, total knee replacement, Femoral nerve catheter, Adductor canal catheter
Brief summary
Open-labelled, randomised controlled trial. Patients will be assessed pre-operatively, at 24 and 48 hours for the primary outcome and secondary outcomes (except for Oxford Knee Score which will be assessed pre-operatively and at 6 months post-operatively by the ortho-paedic team). Primary Objective: To demonstrate whether adductor canal nerve infusions result in superior patient mobilisation within the first 48 hours following total knee replacement compared to femoral nerve catheter infusions. Secondary Objective: To identify whether adductor canal nerve infusions result in superior analgesia within the first 48 hours following total knee replacement compared to femoral nerve catheter infusions.
Detailed description
We are comparing a continuous adductor canal block with a low concentration continuous femoral nerve block. We currently use a low dose femoral nerve catheter based technique as part of our standard treatment strategy for total knee arthroplasty. The use of a catheter provides prolonged analgesia compared to a single shot block, and also allows a lower concentration of local anaesthetic to be employed, thus potentially reducing the incidence of motor blockade. The concentration of local anaesthetic employed in our routine practice (0.0625% L- Bupivacaine) is lower than that routinely used in many other centres, and most clinical studies have compared higher concentrations of local anaesthetic - this might be expected to produce more motor blockade. The concentration we use is higher than the minimum effective concentration for a femoral catheter infusion for knee arthroplasty.
Interventions
PROCEDUREAdductor Canal catheter delivering 0.0625% L- Bupivacaine
Adductor canal catheter: Blockade at mid-thigh. Identify sartorius at mid thigh - find point where the femoral artery begins to descend from sartorius. In plane technique, hydro-dissect space between sartorius and femoral artery. Catheter threaded and 2-4cm left in situ (bevel orientated cephalad). Bolus 20 mls via needle and 5 mls via catheter to confirm spread under ultrasound guidance. Glue/Lockit dressing.
PROCEDUREFemoral nerve catheter delivering 0.0625% L- Bupivacaine
Femoral nerve catheter: Blockade at level of Femoral crease. Identify femoral nerve. In plane lateral approach. Bolus 20 mls via needle. Catheter threaded and 2-4cm left in situ (bevel orientated cephalad).and 5 mls injected via catheter to confirm spread under ultrasound guidance. Glue/Lockit dressing.
Sponsors
University Hospital Plymouth NHS Trust
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Subject has a diagnosis of rheumatoid or osteoarthritis and listed for a primary total knee replacement. * Participant is willing and able to give informed consent for participation in the study. * Male or Female, aged between 18 and 85 years. * American Society of Anesthesiologists (ASA) score I-III * Able (in the clinical staff's opinion) and willing to comply with all study requirements. * Willing to allow his or her General Practitioner and consultant, if appropriate, to be noti-fied of participation in the study.
Exclusion criteria
* Patient refusal * Chronic pain (defined as consumption of \>480mg codeine/24hrs or ANY regular strong opiate consumption by the oral/transdermal route) * Patients aged \<18 or \>85 * ASA score \>III * Body mass index (BMI) \>35 * Lacking mental capacity to give consent to enter trial/undergo surgery * Contraindications to catheter placement (coagulopathy , systemic sepsis or infection at placement site, pre-existing neuropathy) or any other component to the study treatment pathway. * Participant who is terminally ill * Allergy/intolerance to study medications * Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Timed Up Go (TUG) test | 24 hours post-op | This measures the time (in seconds) taken by a patient to rise to their feet from a sitting position, walk 3 metres in a straight line, turn around, walk back to the seat and sit down again. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total opiate consumption | 48 hours post-op | morphine equivalence |
| Visual Analogue Score (VAS) for pain | 24 and 48 hours post-op | Both at rest and on active movement |
| Range of knee flexion | 24 and 48 hours post-op | The range of flexion movement (in degrees) is recorded using a goniometer |
| Maximum Voluntary Isometric Contraction (MVIC) | 24 and 48 hours post-op | The quadriceps muscle power in the operative leg is assessed using a handheld dynamometer (HHD) |
| Oxford Knee Score (OKS) | Pre-op, and at 6 months post-op | Patient reported outcome score. |
Countries
United Kingdom
Outcome results
None listed