Anesthesia, Knee Arthritis, Knee Osteoarthritis, Knee Pain Chronic
Conditions
Brief summary
Adductor canal blocks (ACB) have been recommended in total knee arthroplasty (TKA) to provide better control of post-operative pain, facilitate early ambulation, and reduce length of stay in the hospital. ACB is typically done before surgery by an anesthesiologist, which may increase time per case, cost, and requires the specialized skills of an anesthesiologist trained in regional anesthesia. Recent studies have suggested that surgeons can safely and reliably administer the adductor canal blocks (sACB) during surgery. However, there is currently very limited data on the clinical efficacy of such sACBs, and no studies assessing this technique in the context TKA that are discharged the same day. As such, this randomized control trial (RCT) is being done to compare sACBs to conventional anesthesiologist-performed adductor canal blocks (aACB).
Interventions
PROCEDUREaACB
The patient will undergo a pre-operative single-shot, ultrasound-guided ACB performed by an anaesthesiologist skilled in regional anaesthesia techniques. The ACB will be performed in a dedicated block room, immediately prior to administration of a spinal anaesthetic.
PROCEDUREsACB
The patient will undergo an intraoperative single-shot ACB performed by the treating surgeon following placement of the TKA components.
Sponsors
Ottawa Hospital Research Institute
Canadian Orthopaedic Foundation
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Male and female patients aged 18 years or older 2. Primary TKA booked as SDD 3. Diagnosis of osteoarthritis
Exclusion criteria
1. Inability or refusal to sign informed consent form 2. Non-English or French speaking, and no licensed translator, family member or substitute decision maker available. 3. Non-osteoarthritis primary diagnosis 4. Allergy to analgesic medications 5. Contraindication to spinal and/or regional anaesthesia 6. Any use of opioid pain medication within four weeks of the index procedure(13) 7. Pain catastrophizing scale score ≥16 (8, 9, 14) 8. History of cirrhosis 9. History renal insufficiency 10. History or sensory and/or motor neuropathy to the ipsilateral limb 11. Simultaneous, bilateral TKA 12. Non-TKA prosthesis 13. Scheduled for non-SDD TKA. 14. Preoperative varus/valgus of \>10 degrees. 15. Planned General Anaesthetic 16. Use of Intrathecal Morphine
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Report Pain | Up to 24 hours | Mean Numerical Pain Rating Scale (NPRS) scores on discharge |
| Pain medication use | When spinal anesthesia resolves until 24 hours after surgery | morphine equivalents of pain medication |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to discharge | From PACU to discharge | Post-operative time in minutes to discharge home |
| Admission to Hospital | Up to 24 hours post-operative | Failure to discharge home requiring admission |
| Readmission Rate | Up to 24 hours post-operative | Number of patients readmitted to the hospital within 24 hours |
| Timed Up and Go Test | At discharge | Time is takes, in seconds, to stand, walk 3m, turn around, walk back 3m, and sit back down |
| Patient Reported Quality of Recovery | At 24 hours post-operative | Score on the Quality of Recovery-15 questionnaire |
| Patient Reported Function | pre-operatively, at 2 weeks post-operative | Difference in scores on the Oxford knee score (questionnaire), rated from 0-48 with 48 being the best functional outcome and 0 being the worst |
| Patient Reported Quality of Life | pre-operatively, at 2 weeks post-operative | Difference in scores on the EQ-5D-5L questionnaire (Euro Quality of Life, 5 Dimension, 5 Level), rated from 11111 - 55555, with 11111 being full health and 55555 being worst health |
| Patient Reported Global Health | pre-operatively, at 2 weeks post-operative | Difference in scores on the PROMIS-10 - Global Health (questionnaire), which generates T-scores. Higher T-scores indicate better health. |
Countries
Canada
Contacts
PRINCIPAL_INVESTIGATORSimon Garceau, MD
The Ottawa Hospital
Outcome results
None listed