Comparing Adductor Canal Block and Adductor Canal Block-Local Infiltration Analgesia for Post-operative Pain Management

ACL Injury Clinical Trial

Official title:

Comparison of the Effectiveness of Adductor Canal Block Versus Combination of Adductor Canal Block and Local Infiltration Analgesia: A Randomized Controlled Trial of the Effect on Postoperative Analgesia and Motor Power

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04721119
• Other study ID #: 2382
• Status: Not yet recruiting
• Phase: N/A
• Start date: February 2021
• Est. completion date: November 2021

Study information

• Verified date: January 2021
• Source: Ottawa Hospital Research Institute
• Contact: Meaghan Dufresne
• Phone: 613-737-8899
• Email: meadufresne[@]ohri.ca
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed surgeries amongst young orthopedic surgery patients. Optimal post-operative pain control helps to reduce the opioid burden and to improve the patient's experience. Regional anesthesia, such as the femoral nerve block (FNB) and adductor canal block (ACB), are commonly used for post-operative pain control after surgery. The ACB has replaced the FNB. This is because the ACB targets the femoral nerve, while avoiding the numbing effects on quadricep muscle strength that make it difficult to move the leg. Another form of pain control is local infiltration anesthesia (LIA), which directly blocks pain in the knee. Similar to the ACB, it avoids the numbing effects on the quadricep muscle.This can help improve patient safety and experience by reducing risks of falls and allowing the patient to move earlier. This can also be associated with decreased time in the hospital and decreased costs. Technically, it is less complex and can be done the shorter period of time.

The purpose of this study is to refine the pain management technique following anterior cruciate ligament surgery. More specifically, the aim of this study is to evaluate the effects of LIA alone, and a LIA-ACB combination on post-operative pain and thigh muscle strength.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 100
• Est. completion date: November 2021
• Est. primary completion date: August 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 50 Years

Eligibility

Inclusion Criteria:

• English speaking or any other language with possibility of adequate translation

• ASA I-III patients

• Age 18-50

• BMI = 38 kg/m2

Exclusion Criteria:

• Refusal or inability to provide informed consent

• Any contraindication to regional anesthesia including coagulopathy or bleeding diathesis,

• Allergy to local anesthetics, or infection at the site of the block

• History of long-term opioid intake (more than 3 months use) or chronic pain disorder (more than 3 months)

• History of preexisting neuropathy in the operative leg

• Revision of ACL repair

Related Conditions & MeSH terms

• ACL
• ACL Injury
• ACL Tear
• Anterior Cruciate Ligament Injuries

Intervention

Procedure:
• Local Infiltration Anesthetic
For the local infiltration anesthetic, patients will receive 20 cc of 0.5% ropivacaine, by intra-articular injection performed by the surgeon. The injection is done at the end of the surgical procedure, after suturing the incision.
• Local Infiltration Anesthetic + Adductor Canal Block
For the local infiltration anesthetic, patients will receive 20 cc of 0.25% ropivacaine, by intra-articular injection performed by the surgeon. The injection is done at the end of the surgical procedure, after suturing the incision. For the adductor canal block, patients will receive 20 cc of 0.25% ropivicaine, through injection performed by the anesthesiologist. The injection is done under the sartorius muscle, in mid-thigh, using ultrasound guidance.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Ottawa Hospital Research Institute

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Oral morphine equivalent consumption	Cumulative oral morphine equivalent consumption over 24 hours post-op	Up to 24-hours after surgery
Primary	Quadriceps motor strength	Percent decrease in quadriceps motor strength at 30 minutes following anesthesia compared to baseline	Pre-op, 30 minutes post-anesthesia
Secondary	inta-operative opioid consumption	Cumulative amount of opioids consumed during surgery	during surgery
Secondary	Oral morphine equivalent consumption in PACU	Cumulative oral morphine equivalent consumed in PACU	PACU admission to PACU discharge (approximately 4 hours)
Secondary	Post-operative Pain	area under the curve for rest pain scores during the first 24 hours post-op, using the numeric pain rating scale from 0-10, with 0 being no pain and 10 being the worst possible pain	Up to 24 hours post-operative
Secondary	Quality of Recovery	Measured using the QoR-15 questionnaire at 24 hours post-op	At 24 hours post-operative
Secondary	Time in hospital	Time from admission to discharge	From hospital admission to hospital discharge (approximately 12 hours)
Secondary	Nerve Block Complications	Presence or absence of nerve block complications	up to 24 hours post-operative, up to 2 weeks post-operative