ACL, ACL Injury, ACL Tear
Conditions
Brief summary
Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed surgeries amongst young orthopedic surgery patients. Optimal post-operative pain control helps to reduce the opioid burden and to improve the patient's experience. Regional anesthesia, such as the femoral nerve block (FNB) and adductor canal block (ACB), are commonly used for post-operative pain control after surgery. The ACB has replaced the FNB. This is because the ACB targets the femoral nerve, while avoiding the numbing effects on quadricep muscle strength that make it difficult to move the leg. Another form of pain control is local infiltration anesthesia (LIA), which directly blocks pain in the knee. Similar to the ACB, it avoids the numbing effects on the quadricep muscle.This can help improve patient safety and experience by reducing risks of falls and allowing the patient to move earlier. This can also be associated with decreased time in the hospital and decreased costs. Technically, it is less complex and can be done the shorter period of time. The purpose of this study is to refine the pain management technique following anterior cruciate ligament surgery. More specifically, the aim of this study is to evaluate the effects of LIA alone, and a LIA-ACB combination on post-operative pain and thigh muscle strength.
Interventions
PROCEDURELocal Infiltration Anesthetic
For the local infiltration anesthetic, patients will receive 20 cc of 0.5% ropivacaine, by intra-articular injection performed by the surgeon. The injection is done at the end of the surgical procedure, after suturing the incision.
PROCEDURELocal Infiltration Anesthetic + Adductor Canal Block
For the local infiltration anesthetic, patients will receive 20 cc of 0.25% ropivacaine, by intra-articular injection performed by the surgeon. The injection is done at the end of the surgical procedure, after suturing the incision. For the adductor canal block, patients will receive 20 cc of 0.25% ropivicaine, through injection performed by the anesthesiologist. The injection is done under the sartorius muscle, in mid-thigh, using ultrasound guidance.
Sponsors
Ottawa Hospital Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* English speaking or any other language with possibility of adequate translation * ASA I-III patients * Age 18-50 * BMI ≤ 38 kg/m2
Exclusion criteria
* Refusal or inability to provide informed consent * Any contraindication to regional anesthesia including coagulopathy or bleeding diathesis, * Allergy to local anesthetics, or infection at the site of the block * History of long-term opioid intake (more than 3 months use) or chronic pain disorder (more than 3 months) * History of preexisting neuropathy in the operative leg * Revision of ACL repair
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Oral morphine equivalent consumption | Up to 24-hours after surgery | Cumulative oral morphine equivalent consumption over 24 hours post-op |
| Quadriceps motor strength | Pre-op, 30 minutes post-anesthesia | Percent decrease in quadriceps motor strength at 30 minutes following anesthesia compared to baseline |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative Pain | Up to 24 hours post-operative | area under the curve for rest pain scores during the first 24 hours post-op, using the numeric pain rating scale from 0-10, with 0 being no pain and 10 being the worst possible pain |
| Quality of Recovery | At 24 hours post-operative | Measured using the QoR-15 questionnaire at 24 hours post-op |
| inta-operative opioid consumption | during surgery | Cumulative amount of opioids consumed during surgery |
| Nerve Block Complications | up to 24 hours post-operative, up to 2 weeks post-operative | Presence or absence of nerve block complications |
| Time in hospital | From hospital admission to hospital discharge (approximately 12 hours) | Time from admission to discharge |
| Oral morphine equivalent consumption in PACU | PACU admission to PACU discharge (approximately 4 hours) | Cumulative oral morphine equivalent consumed in PACU |
Contacts
Primary ContactMeaghan Dufresne
Outcome results
None listed