Osteo Arthritis Knee, Pain, Acute, Pain, Postoperative
Conditions
Keywords
Total Knee Arthroplasty, SPANK Block, Adductor Canal Block, Regional Anesthesia
Brief summary
This is a prospective, randomized control trial to compare SPANK block combined with adductor canal block to adductor canal block alone in treatment of post-operative pain after total knee arthroplasty. The primary outcome is pain control, which will be measured throughout the post-operative course using morphine equivalents of opioid analgesics used during the first 24 hours after surgery. Secondary outcomes include pain scores recorded at 4, 8, 12, 16, 20, and 24 hours post-operatively, cumulative pain score, incidence of post-operative nausea and vomiting, and extent of motor blockade. The study will aid in answering the question of whether SPANK block is an effective adjunct in preventing pain and decreasing opioid requirement after TKA.
Interventions
PROCEDURESPANK Block (Sensory Posterior Articular Nerves of the Knee)
Injection of local anesthetic into the tissues on the posterior aspect of the knee to provide sensory blockade of the articular nerves of the knee.
PROCEDUREAdductor Canal Block
Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the knee
DRUGRopivacaine Hcl 0.5% Inj Vil 30Ml
Amide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. The drug itself is not being studied and the same concentration will be used in all participants.
DEVICEPajunk sonoplex stim needle
Echogenic needle used for ultrasound guided nerve blockade.
Sponsors
San Antonio Uniformed Services Health Education Consortium
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients between the ages of 40 and 80 years old undergoing total knee arthroplasty amenable to peripheral nerve block for perioperative analgesia. * BMI \<45 * ASA class III or less
Exclusion criteria
* Inability to sign consent form * Allergy to medications used in the study * Repeat surgery * History of seizure disorder * Simultaneous bilateral TKA * History of substance abuse * BMI \>45 * Opioid consumption of greater or equal to 30mg morphine equivalents per day * Age \<40 or \>80 years old * ASA IV or greater * Inability to use a PCA * Inability to access the intrathecal space * Infection at the site of injection (either for spinal or PNB) * INR greater than or equal to 1.4
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Opioid Consumption | 24 hours postoperatively | Amount of opioids used within the first 24 hours post-operatively, starting from when the patient leaves the operating room, measured in PO morphine equivalents |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Scores | 4, 8, 12, 16, and 24 hours postoperatively | Verbal pain score measured via numerical rating scale from 1-10 at 4 hrs, 8 hrs, 12hrs, 16hrs, and 24 hours. |
| Time to first opioid use | 24 hours postoperatively | The amount of time measured from when the patient leaves the operating room to the time when they receive their first dose of any opioid medication. |
Contacts
Primary ContactAngela M Curell, MD
Backup ContactGregory Stevens, MD
Outcome results
None listed