Anterior Cruciate Ligament Injury, Pain, Postoperative
Conditions
Brief summary
Nerve blocks are used to provide pain control after moderately painful orthopedic surgeries. Anterior Cruciate Ligament (ACL) reconstruction with patellar autograft is a painful orthopedic procedure performed after traumatic injury to the knee. Many patients undergoing ACL reconstruction receive a nerve block as part of their anesthetic care. These blocks can be performed in different locations along the femoral nerve, with advantages and disadvantages to each location. Recently published evidence indicates that there is no short-term difference in pain control between the two commonly-targeted locations (Adductor Canal and Femoral). However, studies involving patients undergoing total knee arthroplasty indicate that femoral blocks provide better pain control with movement than adductor canal blocks. As many patients undergoing ACL reconstruction use continuous passive motion (CPM) machines as part of rehabilitation starting on post-operative day one, the investigators hypothesize that pain control and quality of recovery in the first 48 hours after surgery will be superior with a continuous femoral block than with a continuous adductor canal block. The investigators plan to study this by randomizing patients presenting for ACL reconstruction to receive either a continuous femoral or continuous adductor canal block (both considered adequate means of pain control), and following them to 48 hours to determine the level of pain, quality of recovery score, opioid use, and CPM compliance.
Detailed description
covery score, opioid use, and CPM compliance.
Interventions
PROCEDUREAdductor Canal perineural catheter placement
Patients will receive an Adductor Canal Block intervention for pain control following ACL reconstructive surgeries.
PROCEDUREFemoral Nerve perineural catheter placement
Patients will have a Femoral perineural catheter placed for pain control following ACL reconstructive surgery.
DEVICENimbus pump (Infutronix)
This is a FDA approved infusion device that is used in standard of care to store pain medication and to provide patients with continuous pain control medication at a set rate. This pump will be used for both the Adductor Canal and Femoral Nerve block participants.
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients \>18 years * ASA physical status I, II, or III * Scheduled for ACL reconstruction surgery with patellar autograft
Exclusion criteria
* Pregnancy * Incarceration * Age \<18 * BMI \>35 * Pre-operative opioid use \>15 mg morphine equivalents per day * Inability to communicate with investigators by telephone * Pre-existing neuropathy of the operative extremity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Score | Post-operative day 2 | Participants will report pain on a numeric rating scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Recovery | POD 2 | The Quality of Recovery 15 (QoR 15) is a 15-item questionnaire that is often used to assess how patients are doing in their post-operative course. This survey will be used to assess participants' quality of recovery after ACL reconstructive surgery. |
| Opioid Use | POD 2 | Total morphine equivalents used through POD 2 |
| CPM compliance | POD 2 | number of hours of reported CPM usage through POD 2 |
Other
| Measure | Time frame | Description |
|---|---|---|
| Quality of Recovery | POD 1 | The Quality of Recovery 15 (QoR 15) is a 15-item questionnaire that is often used to assess how patients are doing in their post-operative course. This survey will be used to assess participants' quality of recovery after ACL reconstructive surgery. |
| Bolus dose usage | POD 2 | Total volume of patient-administered bolus doses over the course of the infusion |
| Return to Play | 3 months | Binary variable, whether patient has returned to normal sports activities |
| Quadriceps Circumference, percent of baseline | 3 months | Quadriceps Circumference in cm measured 3 months after surgery, divided by pre-surgery circumference |
Countries
United States
Outcome results
None listed