Arthroplasty, Replacement, Knee, Total Knee Arthroplasty
Conditions
Brief summary
The investigators are evaluating the postoperative outcomes in patients undergoing total knee arthroplasty that receive either systemic lidocaine or ultrasound-guided adductor canal block as part of their anesthetic plan.
Detailed description
Patients scheduled to have total knee arthroplasty will typically receive a single shot adductor canal block to serve as the primary anesthetic and as part of a multi-modal post-operative analgesic plan. The use of adductor canal block is still limited to where trained anesthesiologists in regional anesthesia are available. There are other nonopioid analgesic adjuncts, such as Lidocaine, which is is widely available and is a very commonly used local anesthetic. A major advantage of lidocaine is that it is not associated with a significant side effect profile. Intravenous lidocaine which can be administered during surgery and/or after surgery has demonstrated anti-inflammatory effects and can significantly decrease the reliance on opioid use for adequate pain management in abdominal and spine surgeries. The addition of systemic lidocaine infusion as part of a multimodal analgesia strategy to minimize opioid related side effects might prove to be a useful combination for clinicians where adductor canal blocks are not a viable option. However, the level of evidence comparing the efficacy of intravenous lidocaine versus adductor canal block to reduce postoperative opioid consumption in patients undergoing TKA is limited. We hypothesized that there will be no meaningful clinical difference between systemic lidocaine and ultrasound-guided adductor canal block in the 24-hour postoperative analgesia period.
Interventions
DRUGLidocaine IV
Intravenous lidocaine of 1.5 mg/kg bolus followed by a 1.5 mg/kg/h infusion continuing to the end of phase 1 of post anesthesia care unit
DRUGSaline IV
Intravenous saline of 1.5 mg/kg bolus followed by a 1.5 mg/kg/h infusion continuing to the end of phase 1 of post anesthesia care unit
Sponsors
Rhode Island Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* ASA PS 1-3 patients undergoing primary, unilateral total knee arthroplasty
Exclusion criteria
* ASA PS classification of 4 or greater * Pre-existing neuropathy * Coagulopathy * Chronic opioid consumption (\>3 months) * Infection at the site * Known allergy to study medications (lidocaine) * High grade atrioventricular block (cardiac conduction system impairment) * A history of CVA/TIA * Currently using lidocaine patches * Known liver disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative opioid consumption | 24 hours | Postoperative opioid consumption will be converted to equivalent dose of oral morphine. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain Scores | up to 2 hours (post anesthesia recovery unit), 6 hours, 12 hours, and 24 hours after surgery. | Patients were asked to rate their pain score during rest on a 11-point scale (0 = no pain to 10 = excruciating pain). |
| Quality of Recovery | 24 hours | The QoR-15 questionnaire has 15 questions that assess patient-reported quality of a patient's postoperative recovery using a 11-point numerical rating scale that leads to a minimum score of 0 (poor recovery) and a maximum score of 150 (excellent recovery). |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORVendhan Ramanujam, M.D.
Rhode Island Hospital, Brown University
Outcome results
None listed