Knee Arthropathy, Mobility Limitation, Pain, Acute, Postoperative Pain
Conditions
Keywords
regional anesthesia, knee replacement, pain treatment, rehabilitation
Brief summary
Comparison of continuous adductor canal block to continuous femoral nerve block in patients after total knee arthroplasty. All patients will be anesthetized with spinal anesthesia. Continuous infusion of ropivacaine with a catheter implemented to the adductor canal or next to the femoral nerve. The observed goals: pain intensity, the beginning and quality of rehabilitation.
Detailed description
Written consent will be obtained a day before the surgery. Only subarachnoidally anaesthetised patients may participate in the study. Pencil-point spinal needle and bupivacaine (Marcaine Heavy Spinal 0.5 %) will be used. Before the beginning of operation, under ultrasound control, a catheter will be implemented to one of the chosen position: the adductor canal (the middle or lower third of thigh) or near the femoral nerve (below the inguinal ligament). The local anesthetic solution of 0.2 % ropivacaine will be started with an elastomeric pump (5 mL per hour, up to 72 hours) as soon as a catheter in the right position. The pain will be measured with VAS (visual-analogue scale) 8, 24 and 48 hours after the end of operation, and at the discharge. At the same time, i.e.: 8, 24 and 48 hours from the end of surgery, the range of flexion and extension in the operated knee will be assessed. Moreover, the possibility of patient's sitting, standing up and walking will be noted. All parameters will be reassessed before patients' discharge from the hospital. Each patient will receive paracetamol (1.0) and metamizol (1.0) intravenously (i.v.) q6h. 5 mg of morphine may be given as required, up to 2 dosages per day as a rescue medication.
Interventions
PROCEDUREcontinuous anesthesia of adductor canal
After subarachnoid anesthesia, but before the beginning of surgery, a catheter will be implemented to the adductor canal and infusion of 5 mL/h of 0.2 % ropivacaine will be started.
PROCEDUREcontinuous anesthesia of femoral nerve
After subarachnoid anesthesia, but before the beginning of surgery, a catheter will be implemented next to the femoral nerve (below inguinal ligament) and infusion of 5 mL/h of 0.2 % ropivacaine will be started.
PROCEDURESpinal anesthesia
Before the beginning of surgery all patients will be anesthetised with 0.5 % hyperbaric bupivacaine (Marcaine Heavy), 2.0 - 2.5 mL solution. Pencil point spinal needle will be used.
Sponsors
Konskie Specjalist Hospital
Medical University of Lublin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Participants not aware of the type of continuous blockade.
Intervention model description
Two groups of patients randomly allocated: adductor canal group or femoral nerve group
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* knee arthroplasty * obtained consent * subarachnoid anaesthesia
Exclusion criteria
* coagulopathy * allergy to to local anesthetics * depression, antidepressant drugs treatment * epilepsy * usage of painkiller before surgery * addiction to alcohol or recreational drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption | 24 hours from the end of surgery | Total consumption of intravenous morphine by patients with the use of patient-controlled analgesia pump |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knee flexion | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | range of flexion in operated knee |
| Walking | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | Possibility of walking by patients at scheduled time points |
| The change of acute postoperative pain | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | Measured with VAS (visual-analogue scale) |
| Sitting | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | Possibility of walking by patients at scheduled time points |
Countries
Poland
Outcome results
None listed