Acute Pain, Regional Anesthesia Morbidity
Conditions
Keywords
Adductor Canal Catheter, Intraarticular Catheter, Arthroplasty, Replacement, Knee
Brief summary
The study is a prospective randomized controlled trial comparing intraarticular catheters and adductor canal catheters for postoperative analgesia following a primary Total Knee Arthroplasty (TKA).
Detailed description
The study is a prospective, randomized controlled clinical trial comparing two methods of postoperative analgesia following primary TKA. Eligible primary TKA patients must be ASA I - III and require less than 20 mg oxycodone daily (or its equivalent). Exclusion criteria are: allergy to anesthetics, contraindication to regional anesthesia, sensory/motor disorder involving operative limb, non-english speaking, ASA IV or greater, psychiatric or cognitive disorders, incarceration, renal insufficiency with Cr \> 2.0 and hepatic failure. When patients agree to participate in the study the following data will be collected by the research staff: ASA physical status, age, height, weight, gender, quantitative opiate use, numeric pain score with visual descriptors, painDETECT score (form included), WOMAC score (form included) and baseline Pain Management Questionnaire. When designated through randomization, intra-articular catheters will be placed intraoperatively by the surgeons, per usual protocol. ACC's will be placed postoperatively in the PACU. The catheters will exit the bandage in a similar fashion to blind the personnel collecting data, postoperatively. Those collecting data will not be blinded from identifying patients in the control group, as no catheter will exit the bandage. Potential risks for each procedure, which will be explained to the patient, include: bleeding, local infection, local anesthetic toxicity in the form of seizure and cardiac arrest and neuropathy. The preceding are commonly listed though infrequent complications of both procedures. Continuous ultrasound will guide the placement of the ACC.
Interventions
PROCEDUREAdductor Canal Catheter
0.5% Ropivicaine for primary block and 0.2% Ropivicaine infusion by OnQ Pump
PROCEDUREIntraarticular Catheter
0.5% Bupivicaine for primary block and 0.125% Bupivicaine infusion by OnQ Pump
DRUGRopivicaine
DRUGBupivicaine
Sponsors
Thomas Jefferson University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
40 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Age 40-85 * American Society of Anesthesiologists (ASA) Physical Status (PS) 1-3. * Undergoing Unilateral, Primary, Total Knee Arthroplasty * English as native language
Exclusion criteria
* Patient refusal * History of opioid dependence * Contraindication to peripheral nerve block * Pre-existing significant neuropathy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative pain | immediately postoperative period to post-operative day # 2 | postoperative pain as measured by Visual Analog Scale at rest and with movement |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative opioid consumption | immediat postoperative period to postoperative day # 2 | Opioid consumption within hospitalization |
| Chronic post-surgical pain | 6-8 weeks post-operative | Assess post-surgical pain and function as measured by PainDetect and WOMAC questionnaires at 6-8 weeks post-operative compared to preoperative pain and function |
| Participation in Physical therapy | immediate postoperative period to postoperative day #2 | Physical therapy benchmarks such as active and passive range of motion |
Outcome results
None listed