Osteo Arthritis Knee, Gonarthrosis
Conditions
Keywords
Osteo Arthritis Knee, Gonarthrosis, Regional anesthesia, Analgesia, Postoperative analgesia, Total knee replacement, Continuous femoral nerve block, Femoral nerve block, Continuous adductor canal block, Adductor canal block
Brief summary
Total knee replacement (TKR) is considered the most effective and safe method of radical treatment of late stages of knee osteoarthritis. A well-known problem of TKR is a severe postoperative pain syndrome, which is observed in more than 50% of patients. Femoral nerve block (FNB) is the gold standard for continuous postoperative analgesia after total knee replacement, as it is effective in reducing the frequency of use of opioid analgetics and reduce the duration of hospitalization. At the same time, the negative effect of this method is the motor blockade of the quadriceps femoris muscle which leads to functional impairment and is associated with an increased risk of falling. Adductor canal block (ACB) provides adequate analgesia comparable to femoral nerve block. Moreover, ACB doesn't affect the motor function of the quadriceps femoris muscle. The possibility of enhanced recovery after total knee replacement is the reason to compare single-shot adductor canal block and continuous femoral nerve block.
Interventions
PROCEDURESingle-shot adductor canal block
Postoperative analgesia in this group will be carried out by a single-shot bolus of 20 ml Ropivacaine 0.5% in the region of the middle third of the adductor canal.
PROCEDUREContinuous femoral nerve block
Postoperative analgesia in this group will be carried out by continuous infusion of local anesthetics through a catheter installed to the femoral nerve in the area of the femoral triangle. Ropivacaine 0.2% solution will be used for postoperative analgesia. Local anesthetic infusion rate is 4 ml/h to 10 ml/h.
Sponsors
Negovsky Reanimatology Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 * Planned primary total knee replacement * Planned neuraxial anesthesia * Written informed consent
Exclusion criteria
* Urgent surgery * Planned revision total knee replacement * Known allergic reaction to anesthetics * Confirmed localized infection at the puncture sites * Confirmed localized tumor at the puncture sites * Peripheral neuropathy of the lower extremities * Parkinson's disease * Previously enrolled in this trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ambulation distance | postoperative day 1 | Less meters means worse outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ambulation distance | postoperative day 2 | Less meters means worse outcome |
| Timed up and go test | postoperative day 1 | More seconds means worse outcome |
| 10 meters walk test | postoperative day 1 | More seconds means worse outcome |
| 30 seconds chair stand test | postoperative day 1 | Less exercise done means worse outcome |
| time to readiness to dicharge | 30 day | time from the day of surgery to the day of readiness to discharge |
| length of hospitalization | 30 day | time from the day of surgery to the day of discharge |
| 5 times sit to stand test | postoperative day 1 | More seconds means worse outcome |
Other
| Measure | Time frame | Description |
|---|---|---|
| intravascular local anesthetic injection | 30 day | frequency of intravascular local anesthetic injection |
| neuropathy after the procedure | 30 day | frequency of neuropathy after the procedure |
Countries
Russia
Contacts
Primary ContactValery Likhvantsev
Backup ContactLevan Berikashvili
Outcome results
None listed