Anesthesia, Knee Arthroplasty, Nerve Block, Nerve Pain, Pain
Conditions
Brief summary
The purpose of this study is to determine which technique for catheter placement in continuous femoral nerve block (FNB) is most successful - guidance with (1) ultrasound or (2) nerve stimulation and ultrasound. Sensory and motor assessment scores will be obtained post-FNB. Patient controlled analgesia and opiate consumption is also recorded along with pain scores for the first 48 hour post-FNB.
Detailed description
Continuous femoral nerve block (cFNB) is a widely used regional anesthetic technique for many lower limb operations, such as total knee arthroplasty (TKA), anterior cruciate ligament repair, tibial osteotomy and patellar surgery. It provides superior pain relief, faster ambulation, shorter hospital stays and less risk of side effects in comparison to patient controlled analgesia (PCA), local anesthetic wound infiltration, or single shot femoral nerve block (FNB). Stimulating catheters were introduced in 1999 to provide an objective end point to guide continuous nerve block catheter position by maintaining the desired evoked muscle response with nerve stimulation (NS). The main advantages of stimulating catheters are faster onset of sensory and motor block and reduction of local anesthetic drugs consumption. In recent years the precise insertion of continuous catheters has improved especially with the introduction of ultrasound (US)-guided imaging to regional anesthesia practice and advances in scanning techniques. That led to a call to reduce cost by switching to non-stimulating catheters. However, most studies comparing both catheters lacked anesthetic technique standardization and adequate sample size. In this prospective randomized controlled trial, we compared postoperative analgesic efficacy and opioids consumption in patients having cFNB insertion using US alone and that of US combined with NS.
Interventions
DEVICEUltrasound
Femoral catheter inserted using ultrasound only
DEVICEUltrasound + Nerve Stimulation
Femoral catheter inserted using ultrasound and nerve stimulation
Sponsors
Sunnybrook Health Sciences Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists physical status I to III patients * Aged 18-75 scheduled for unilateral TKA
Exclusion criteria
* History of significant psychiatric problems * BMI \> 40 kg/m\^2 * Prior surgery in the inguinal region * Neurological disease with sensory or motor deficit * Diabetic neuropathy * Contraindication to any study medications * Daily opioid consumption \>10 mg PO morphine (or equivalent) for 2 weeks prior to surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean numeric pain score (NRS) | 24 hours post-block insertion | Pain score assessed 24 hours post-block insertion using numeric pain scale from 0-10 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to perform the block | At the time of block procedure | Time required to perform the block procedure |
| Sensation over the skin of the thigh to determine sensory block using 3 point grading scale | 30 min post-block insertion | Sensory block evaluation examined the sensation over the skin of the thigh |
| Quadriceps muscle strength to determine motor block using 3 point grading scale | 30 min post-block insertion | Motor block evaluation examined quadriceps muscle strength by grading the ability or inability to extend the leg of the limb to be operated on against gravity after the hip is passively flexed at 45° |
| Total hydromorphone used (oral and intravenous PCA) | 24 hours post-block | Total amount of hydromorphone consumed within 24 hours post-block |
Countries
Canada
Outcome results
None listed