Total Knee Arthroplasty
Conditions
Keywords
Adductor Canal Block, Total Knee Arthroplasty
Brief summary
This study aims to compare the functional recovery of patients undergoing Total Knee Arthroplasty based on the administration of an adductor canal block during their anesthesia treatment
Detailed description
The period after total knee replacement (TKR) surgery is known to be painful for the first 24 hours, lasting up to 3 days in many cases. Successful management of pain after TKR is regarded as necessary to early recovery, rehabilitation and timely discharge. Severe pain following major joint arthroplasty can hinder early rehabilitation, may result in prolonged hospitalization and is a strong predictor of persistent pain beyond 3 months. Adequate analgesia following TKR is paramount to early recovery, rehabilitation and timely discharge. Therefore early postoperative analgesic and rehabilitation goals are intricately related. Until now, different methods of pain treatment have been used, including intravenous narcotic pain medication, continuous femoral nerve block (numbing medication to a nerve in the thigh) and epidural analgesia (identical to the numbing method for childbirth). These are all effective methods but each is limited by side effects. In recent years, research has focused on administering local anesthetic further down in the leg, trying to minimize quadriceps muscle weakness while giving adequate pain relief after surgery. Local Infiltration Analgesia (LIA) and Adductor Canal Block (ACB) are examples of new farther sites of administration. The purpose of this study is to determine which combination of analgesic interventions is the most effective treatment for pain and improvement in functional outcome for TKR.
Interventions
DRUGAdductor Canal Block
Use of ropivacaine 0.5% with 1:400,000 epinephrine in the adductor canal along with a spinal anesthesia of 3ml 0.5% preservative-free bupivacaine.
DRUGAdductor Canal Block with Morphine
Use of ropivacaine 0.5% with 1:400,000 epinephrine in the adductor canal along with a spinal anesthesia of 3ml 0.5% preservative-free bupivacaine and 100mcg of intrathecal morphine (0.1ml of intrathecal morphine 1mg/ml)
DRUGLocal Infiltration
30 ml normal saline in the adductor canal along with a spinal anesthesia of 3ml 0.5% preservative-free bupivacaine, in addition to the local infiltration.
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists Physical Status I-III * 18 - 80 years of age * BMI 18 - 40 * Scheduled for elective total knee replacement under spinal anesthesia * Able to ambulate independently with a standard wheeled walker as maximum mobility aid
Exclusion criteria
* Revision knee arthroplasty * Bilateral knee arthroplasty * Lack of mental ability to provide informed consent * Neuropathic pain or sensory disorders of the surgical limb * Contraindication to regional anesthesia (intolerance to the study drugs, bleeding diathesis, coagulopathy, malignancy or infection at the site of block) * Chronic opioid use defined as \> 30 mg of daily oral morphine equivalents
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Timed Up and Go test | 2-3 days post srugery | TUG test reflects the time it takes a subject to stand up from a standard height armchair, walk 3 meters, walk back to the chair and sit down. It intends to assess a patient's global mobility as well as balance and risk of falling. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain outcome - NRS | 2-3 days post surgery | a) Pain scores assessed with an 11 point verbal numeric rating scale (NRS) where 0 is no pain and 10 is the worst pain imaginable, both at rest and during active physiotherapy (measured daily for 3 days post-operatively) . |
| Analgesic outcomes - Proportion of patients who required rescue intravenous patient controlled analgesia | 2-3 days post surgery | Proportion of patients who required rescue intravenous patient controlled analgesia (iv PCA) anytime in the post-operative period. |
| Analgesic outcomes - Incidence of opioid-related side effects | 2-3 days post surgery | Incidence of opioid-related side effects |
| Secondary short-term physical and performance-based functional outcome measures - Proportion of patients achieving knee flexion range of motion (ROM) of 90 degrees | 2-3 days post surgery | Proportion of patients achieving knee flexion range of motion (ROM) of 90 degrees (measured daily for 3 days post-operatively) |
| Analgesic outcomes - Cumulative systemic opioid consumption | 2-3 days post surgery | Cumulative systemic opioid consumption measured as oral morphine mg equivalents (daily for 3 days post-operatively). |
| Secondary short-term physical and performance-based functional outcome measures - Hospital length of stay | 2-3 days post surgery | Hospital length of stay |
| Secondary short-term physical and performance-based functional outcome measures - Discharge destination | 2-3 days post surgery | Discharge destination (home or rehabilitation facility) |
| Medium-term self-reported functional outcome measures - WOMAC | baseline and 2-3 days post surgery | Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured at baseline and at 3 months post-operatively |
| Medium-term self-reported functional outcome measures - LEFS | baseline and 2-3 days post surgery | Lower extremity functional scale (LEFS) measured at baseline and at 3 months post-operatively. |
| Secondary short-term physical and performance-based functional outcome measures - Distance walked | 2-3 days post surgery | Distance walked |
Countries
Canada
Outcome results
None listed