Arthroplasty, Knee, Replacement
Conditions
Brief summary
This study compares the analgesic efficacy of single-dose adductor canal block (sACB) versus continuous-dose adductor canal block (cACB) for postoperative pain management in total knee replacement patients. To ensure a high level of clinical accuracy, the investigation specifically focuses on a cACB cohort where ultrasound confirmation ensures the catheter remains correctly positioned for a full 48 hours. Participants are assigned to groups using a 1:1 randomization protocol via computer-generated tables to eliminate selection bias. Clinical consistency is maintained by using identical pharmacological agents across both groups: 0.5% Heavy Bupivacaine for spinal anesthesia and 0.5% ropivacaine with 1:200,000 epinephrine for the nerve block itself. Furthermore, both groups adhere to a standardized multimodal analgesic schedule to control for external variables. In the cACB group, intravenous patient-controlled analgesia (IV PCA) serves as a designated rescue therapy should the catheter fail. The primary technical evaluation occurs 48 hours post-surgery, utilizing ultrasound to verify catheter placement and quantify pain levels. Beyond immediate recovery, the study evaluates long-term success through Patient-Reported Outcome Measures (PROMs) at a 12-week follow-up, focusing on functional restoration and the patient's overall quality of life. By isolating the variable of catheter stability, the research aims to provide a definitive comparison of whether the continuous delivery of local anesthetic offers a statistically significant clinical advantage over a single-dose administration in the context of modern orthopedic recovery protocols.
Interventions
PROCEDUREContinuous ACB
Adductor canal block, a lower extremity nerve block technique for postoperative pain control, is performed under ultrasound guidance for patients undergoing total knee arthroplasty, and is carried out by inserting a catheter. The catheter is connected to a PCA pump following insertion, with a continuous infusion rate for two days post-surgery.
PROCEDURESingle-shot ACB
Adductor canal block, a lower extremity nerve block technique for postoperative pain control, is performed under ultrasound guidance for patients undergoing total knee arthroplasty, and is carried out by a single-shot local anesthetic administration.
Sponsors
Yonsei University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 40-80 yrs * Scheduled for unilateral total knee arthroplatsy * ASA I-III * BMI 18-35 kg/㎡ * Able to read and understand consent form
Exclusion criteria
* Allergy to local anesthetics * Infection at the block site * History of neuropathy or peripheral nerve disease * Coagulation disorders or use of anticoagulants (if discontinuation is not possible) * Communication disorders or cognitive impairment * Chronic opioid use (≥30 MME/day, 3 months or more) * Severe chronic pain (NRS ≥7/10, 3 months or more) * Renal impairment (eGFR \<30 mL/min/1.73m²) * Hepatic impairment (Child-Pugh C) * Blood coagulation disorders * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| postoperative pain score at rest (Area Under Curve, AUC) | postoperative 48 hours | 48-hour postoperative pain score at rest (Area Under Curve, AUC) using NRS. |
Contacts
CONTACTeunjung Kim
Outcome results
None listed