Knee Arthropathy
Conditions
Keywords
Adductor canal block, local infiltration analgesia, Postoperative pain management, Quadriceps strength, Total knee arthroplasty, Local anesthesia
Brief summary
To investigate the efficacy of two different regimens of local anesthetic boluses for continuous adductor canal block under ultrasound-guidance in total knee arthroplasty at King Chulalongkorn Memorial Hospital.
Detailed description
Total knee arthroplasty (TKA) is a commonly performed surgical procedure for patients with severe knee osteoarthritis. However, one of the challenges associated with TKA is the significant postoperative pain experienced by patients, which can delay early mobilization and physical therapy. Uncontrolled pain worsens patient outcomes and healthcare costs as it can increase the risk of complications after surgery. Therefore, effective pain management is important for optimizing patient outcomes and promoting a smooth recovery process.Despite the absence of a standardized recommendation for the volume and concentration of bolus administration in continuous adductor canal block (CACB), many previous studies, have demonstrated the efficacy of a high-dose bolus followed by a low-concentration local anesthetic infusion for CACB. However, these trials exhibited differences in the doses and volumes of bolus injection. Therefore, the necessity of high concentration and volume bolus CACB in combination with comprehensive multimodal analgesia and LIA for postoperative pain management in TKA remains uncertain. The aim of this study is to investigate the efficacy of two different regimens of local anesthetic used in boluses for continuous adductor canal block under ultrasound-guidance in total knee arthroplasty at King Chulalongkorn Memorial Hospital.
Interventions
DRUGLow bolus concentration and volume
Compare Low and Standard concentrations and volumes of bupivacaine boluses for continuous adductor block
Sponsors
Chulalongkorn University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients undergoing TKA aged more than 18 years * Patients with American Society of Anesthesiologists (ASA) class 1-3 * Patients with body weight index (BMI) 18-40 kg/m2
Exclusion criteria
* Patient refusal to participate * Patients with known allergic to medications used in the research protocol * Patients with contraindications to neuraxial or regional anesthesia, including existing neuropathy or neurological deficits involving the lower extremities, coagulopathy or bleeding diathesis and local skin infections * Patients with contraindications to NSAIDs such as history of coronary artery bypass graft surgery, congestive heart failure, stroke, gastrointestinal bleedings or ulceration, asthma, hepatic and renal disease, abnormal coagulation, or pregnancy * Patients with chronic opioid use (opioids have been used daily or almost daily for more than three months or sixty milligrams or more of morphine has been used daily for more than one month) or diagnosed with neuropathic pain * Patients that are unable to perform preoperative Quantitative sensory testing.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average knee pain score assessed by Numerical rating scale (NRS) | 6 hours after surgery | Average postoperative pain score assessed by NRS from 0-10 (0= no pain, 10= the worst pain imaginable) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The degree of active range of motion (ROM) of knee joint | preoperative - postoperative day 2 | Evaluate patient's functional outcomes by the degree of knee active ROM (measured by a goniometer) at preoperative and postoperative day 0,1,2 |
| Functional outcomes assessed by Five Times Sit to Stand Test (5XSST) | preoperative - postoperative day 2 | Evaluate patient's functional outcomes by 5XSST at preoperative and postoperative day 0,1,2 |
| Functional outcomes assessed by Time Up and Go (TUG) test | preoperative - postoperative day 2 | Evaluate patient's functional outcomes by TUG tests at preoperative and postoperative day 0,1,2 |
| Postoperative pain score assessed by Numerical rating scale (NRS) | preoperative to day 7 after hospital discharge | Postoperative pain score at rest and on movement assessed by NRS from 0-10 (0= no pain, 10= the worst pain imaginable) |
| postoperative complications assessed by Likert scale | postoperative day 0-2 | postoperative complications such as nausea/vomitting, sleep disturbance and fall assessed by Likert scale from 1-7 (1 = strongly disagree/ extremely unlikely, 2 = disagree/ unlikely, 3 = slightly disagree/ slightly unlikely, 4 = either, 5 = slightly agree/ slightly likely, 6 = agree/ likely, 7 = strongly agree/ extremely likely) |
| The time to first rescue analgesia | postoperative day 0-2 | the period from the CACB administration to the first IV morphine administration |
| Quadriceps strength assessed by maximum voluntary isometric contraction (MVIC) in Newton | preoperative - postoperative day 2 | Quadriceps strength assessed by MVIC in Newton at 90 degrees at preoperative and postoperative day 0,1,2 |
| morphine consumption in milligrams | post0perative day 0-2 | Patient's morphine consumption at postoperative day 0,1,2 |
Other
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital stay assessed by hours | postoperative day 2 | Evaluate length of hospital stay (from admission to hospital discharge) by hours |
| patient satisfaction assessed by Numerical rating scale (NRS) | 48 hours after surgery and 7 days after hospital discharge | Evaluate patient satisfaction by NRS from 0-10 (0= no pain, 10= the worst pain imaginable) |
Countries
Thailand
Outcome results
None listed