Adductor Canal Block, Anesthesia
Conditions
Brief summary
The adductor canal block (ACB) is the standard of care for analgesia after Anterior Cruciate Ligament (ACL) repair. ACB is performed by injecting local anesthetic (freezing) in the subsartorial canal in the thigh which is about 7-10cm long. Preliminary evidence suggests that different injection sites within the canal may produce different degrees of analgesia and quadriceps motor block. This trial seeks to determine the effects of various ACB injection sites on postoperative analgesia and motor power following ACL repair.
Detailed description
Adductor canal block (ACB) is replacing femoral nerve block (FNB) as the peripheral nerve block of choice for knee surgery. The ACB aims to inject local anesthetics (LA) within the neurovascular sheath in the subsartorial adductor canal around the femoral nerve. The point where the sartorius muscle crosses over the femoral artery is generally the accepted site for performing ACB. Clinically, injecting LA in the adductor canal blocks the sensory innervation of the knee and thus offers pain relief that is similar to FNB while conserving motor power around the knee. While these benefits are desirable, the exact location for performing ACB that ensures these benefits, remains debatable. The subsartorial adductor canal itself is 7-10cm long and the anatomical location of the sensory and motor nerves that innervate the knee and its surrounding muscles in this canal may vary. This randomized controlled trial is designed to identify and refine the ACB technique by clinically determining the effects of various ACB injection locations on postoperative analgesia and quadriceps motor power following ACL repair.
Interventions
DRUGlidocaine
Local anesthetic
DRUGropivacaine
Local anesthetic
Sponsors
Women's College Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Patients booked for anterior cruciate ligament surgery under general anesthesia * English speaking * BMI \<38 kg/m2
Exclusion criteria
* Refusal or inability to provide informed consent * Allergy to local anesthetics * Contraindication to regional anesthesia including coagulopathy or bleeding - diathesis * Infection * Nerve Injury at the site of the nerve block * Malignancy at the site of the nerve block * History of drug and/or alcohol dependence * History of long term opioid intake or chronic pain disorder * History of pre-existing neuropathy in the operative leg * History of significant psychiatric conditions that may affect patient assessment * Inability to understand the informed consent and demands of the study * Allergy to any of the components of multi-modal analgesic regimen * Revision ACL repair
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative 24 Hour Oral Morphine Equivalent Consumption | 24 hours | Post-Operative Analgesia |
| Motor Power - Peak Force as measured by a dynamometer | 30 Minutes post Block | Percentage decrease in quadriceps motor strength at 30 minutes following adductor canal block compare to baseline |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain Scores - Questionnaire | 24 hours post block | Area under the curve for rest pain scores plotted against time during the first 24 hours |
| Quality of Recovery (QoR-15) | 24 hours postoperatively | Quality of recovery measured using the QoR-15 at 24 hours postoperatively |
| Opioid Consumption | During surgical procedure | Intra-operative opioid consumption |
| Hospital Discharge (Time to hospital discharge) | Same day as surgical procedure | Time to hospital discharge |
| Nerve Block Complications | 24 hours postoperatively and 2 weeks postoperatively | Presence/absence of nerve block complications during the first 24 hours postoperatively and 2 weeks after surgery |
| Patient Satisfaction - Questionnaire | 24 hours postoperatively | Patient satisfaction with analgesia - NRS Pain Scale 0(no pain to 10(worst pain) |
| Total opioids in Post Anesthetics (PAC) | Total length of time in PACU (total time in minutes from arrival in PACU to discharge to the Surgical Day Care is between 60-180 minutes | Cumulative oral morphine equivalent consumption in PACU |
Countries
Canada
Outcome results
None listed