Acute Postoperative Pain, Surgery
Conditions
Keywords
regional anesthesia, total knee arthroplasty, nerve block
Brief summary
This is a single-center pilot study to determine if an adductor canal continuous nerve block is superior to single injection nerve block following total knee arthroplasty. Investigators will randomize participants to either continuous nerve block or single injection nerve block for the adductor canal preoperatively. They will assess differences in pain (measured in numeric rating scale), opioid consumption, and physical therapy milestones from postoperative day 0 to 7.
Detailed description
Adductor canal blocks are standard care for postoperative analgesia following total knee arthroplasty. Adductor canal blocks involve depositing local anesthetic (ropivacaine) around the saphenous nerve at the location of the adductor canal on the ipsilateral thigh. At UCSD, the standard care is to perform single injection adductor canal blocks for research participants undergoing total knee arthroplasty prior to surgery in the preoperative waiting area. Participants will be randomized to either: (1) single injection with ropivacaine (0.5%) of the adductor canal block AND a 5-day continuous perineural infusion of ropivacaine (0.2%) (experimental group); versus (2) single injection with ropivacaine (0.5%) of the adductor canal block and no continuous nerve block added.
Interventions
DEVICEcontinuous peripheral nerve block with OnQ pump
For continuous nerve blocks, the infusion pump that will be used are OnQ pumps (Avanos, Alpharetta, GA) and pre-filled with ropivacaine 0.2% and provided by UCSD's Investigational Drug Services.
DRUGsingle injection nerve block
An adductor canal single injection nerve block will be performed per standard of care. The adductor canal will be identified by ultrasound in the short-axis view. The distal aspect of the femoral triangle (and beginning of the adductor canal) will be identified distal to the mid-thigh in the ipsilateral limb. Using ultrasound guidance, a standard Tuohy block needle will be advanced through a skin wheal of lidocaine until its tip is in the hypoechoic area immediately distal saphenous nerve adjacent to the femoral artery. Twenty milliliters of ropivacaine 0.5% will be injected in divided doses with repeated negative aspiration.
Sponsors
University of California, San Diego
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Adult participants of at least 18 years of age 2. Undergoing a primary, unilateral, total knee arthroplasty 3. Planned single-injection adductor canal nerve block 4. Weight \> 50 kg (to minimize the risk of local anesthetic toxicity)
Exclusion criteria
1. chronic opioid or tramadol use: daily oxycodone equivalents \> 20 mg for \> 4 weeks 2. neuro-muscular deficit of the surgical limb 3. moderate pain (NRS \> 3) in an anatomic location other than the surgical site 4. planned hospital admission following surgery 5. history of opioid misuse 6. those who lack capacity to complete informed consent 7. inability to contact the investigators during the treatment period, and vice versa (e.g., lack of telephone access) 8. incarceration 9. pregnancy 10. allergy to amide local anesthetics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| analgesic effect of 5-day continuous nerve block of the adductor canal relative to a single inection nerve block with ropivacaine. | 7 days | Numeric Rating Scale (NRS) for pain will be superior daily with continuous adductor canal blocks on postoperative days 1-7 following total ankle arthroplasty as compared with single-injection adductor canal blocks (as measured by the average daily NRS within the Brief Pain Inventory) |
| opioid consumption of 5-day continuous nerve block of the adductor canal relative to a single inection nerve block with ropivacaine. | 7 days | Opioid consumption will be superior daily with continuous adductor canal blocks on postoperative days 1-7 following total ankle arthroplasty as compared with single-injection adductor canal blocks (measured in oxycodone equivalents) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| physical and emotional functioning of 5-day continuous nerve blocks relative to a single injection nerve blocks with ropivacaine | 7 days | The physical and emotional functioning of research participants will be superior daily with continuous adductor canal blocks on postoperative days 1-7 following total ankle arthroplasty as compared with single-injection adductor canal blocks (as measured with the Brief Pain Inventory Interference Subscale) |
| improvement in physical therapy milestones of 5-day continuous nerve blocks relative to a single injection nerve blocks with ropivacaine | 30 days | Knee injury and osteoarthritis outcome score for joint replacement (KOOS JR) |
| 30-day pain score measured in Numeric Rating Scale | 30 days | At around 30 days postoperatively, the patients average pain score measured in the numeric rating scale (0-10) will be assessed. |
| 30-day postoperative opioid consumption | 30 days | Around 30 days postoperatively, the average opioid consumption will be assessed. This will be based on the average opioid consumption over the preceding week at 30 days. |
Countries
United States
Contacts
Primary ContactRodney A Gabriel, MD
Outcome results
None listed