Total Knee Arthroplasty
Conditions
Brief summary
The goal of this observational study is to determine the incidence of dislodgement for adductor canal catheters after total knee arthroplasty on post-operative day 1. We will also attempt to identify factors associated with secondary catheter failure.
Detailed description
Total knee arthroplasty (TKA) is a common procedure for indications including osteoarthritis and malignancy involving the knee, with over 55,285 knee replacements performed between 2020-2021 in Canada. Ultrasound guided continuous adductor canal block (cACB) is the standard of care for postoperative analgesia for this procedure. The catheter is not always as effective at providing analgesia as would be expected - which could be due to displacement of the catheter. This displacement is most likely to occur peri-operatively or during physiotherapy post-operatively and as such, post-operative assessments can provide useful insight into causes of secondary failure. This prospective observational study aims to estimate the cACB dislodgment on POD 1 rate at a high volume, tertiary care referral centre, and identify factors associated with dislodgement and clinical sequelae. As this is an observational/QI study of the current standard of care at Sunnybrook Health Sciences Centre, anesthesiologists are free to use the cross sectional versus parallel insertion of the cACB per their discretion.
Interventions
PROCEDUREAdductor Canal Catheter
Ultrasound guided Adductor Canal Catheter for total knee arthroplasty analgesia
Sponsors
Sunnybrook Health Sciences Centre
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for Total Knee Arthroplasty * Older than 50 years
Exclusion criteria
* Body Mass Index greater than 40 * Chronic opioid consumption (greater than 30mg oral morphine equivalent daily) * Contraindication to Adductor Canal Catheter
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adductor Canal Catheter tip in correct position on postoperative day 1 | Postoperative day 1 (08:00AM) | Ultrasound confirmation of injectate spread adjacent to the femoral artery on postoperative day 1 (08h00) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensory block | Postoperative day 1 (08:00AM) | Loss of sensation in the saphenous nerve distribution on postoperative day 1 (08h00) |
| Postoperative opioid consumption (08h00) | Postoperative day 1 (08:00AM) | Cumulative opioid consumption after total knee arthroplasty to postoperative day 1 (08h00) |
| Numeric Rating Scale for Pain (NRS) at rest on postoperative day 1 (08h00) | Postoperative day 1 (08:00AM) | Maximum pain score on 0-10 Likert Scale |
| Adductor Canal Catheter tip in correct position after insertion | Preoperative | Ultrasound confirmation of injectate spread adjacent to the femoral artery before surgery |
Other
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction with analgesia on postoperative day 1 | Postoperative day 1 (08:00AM) | Patient satisfaction measured by 0-10 Likert Scale |
| Adductor catheter occlusion | Postoperative day 1 (08:00AM) | Any recording of local anesthetic infusion pump recording an occlusion |
Countries
Canada
Outcome results
None listed