Enhanced Recovery After Surgery (ERAS) Total Knee Replacement (TKR) With a Transitional Pain Service

Anesthesia Clinical Trial

— EKAT-TeleTPS  

Official title:

Expanding the Peri-operative Surgical Home Model: ERAS TKR With a Transitional Pain Service (TeleTPS)- Continuous Adductor Canal Catheter Versus Adductor Canal Block for Total Knee Arthroplasty, a Randomized Double-blind Controlled Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03747146
• Other study ID #: 2017-1858
• Status: Recruiting
• Phase: N/A
• Start date: November 16, 2018
• Est. completion date: December 2025

Study information

• Verified date: March 2024
• Source: Hospital for Special Surgery, New York
• Contact: George Birch, BS
• Phone: 212-774-7377
• Email: birchg[@]hss.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A comparison of two anesthetic techniques for total knee replacements: (1) Peri-Articular Injection (PAI), local infiltration between the popliteal artery and capsule of the knee block (IPACK) and single-shot adductor canal block (ACB) vs. (2) PAI, IPACK and continuous adductor canal block catheter (ACC).

Description:

Patients will be randomized to one of two groups: one group will receive a PAI, IPACK and single-shot adductor canal block; one group will receive PAI, IPACK and continuous adductor canal block catheter.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 94
• Est. completion date: December 2025
• Est. primary completion date: December 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Patients with osteoarthritis scheduled for a primary total knee arthroplasty with a participating surgeon

• Planned use of regional anesthesia

• Ability to follow study protocol

• English speaking (secondary outcomes include questionnaires validated in English only)

• Lives within one hour of the hospital

• Has a smart phone

Exclusion Criteria:

• Hepatic or renal insufficiency

• Younger than 18 years old or older than 65 years ol

• Patients undergoing general anesthesia

• Allergy or intolerance to one of the study medications

• BMI >40

• Diabetes

• American Society of Anesthesiologists (ASA) status III or IV

• Chronic gabapentin/pregabalin use (regular use for longer than 3 months)

• Patients with chronic pain (from a referral to chronic pain service) or a pain catastrophizing scale (PCS >30)

• Patients with severe valgus deformity or flexion contracture

• Patients unable to follow home catheter instructions and unwilling to go home with an infusing catheter

• Patients who have no home caregivers in the event that a catheter is to be sent home with the patient

• Patients with planned stay at rehab facility (to avoid medical device being tampered with at the rehab facility)

• Non-English speakers (secondary outcomes include questionnaires validated in English only)

Related Conditions & MeSH terms

• Anesthesia

Intervention

Device:
• Continuous Adductor Canal Catheter (ACC)
At the end of the case or in the PACU, a pseudo sham catheter will be affixed mid-thigh to the skin using dermabond, steri-strips, and a chg tegaderm dressing. The catheter will be connected to the disposable pump filled with sterile saline (400 cc) and the flow rate will be set to 0. The pump will be enclosed in a carrier bag provided by the company. To ensure blinding, the carrier bag will be taped to prevent the patient from accessing it.
• Adductor Canal block with sham catheter
Adductor canal block (ACB) will be administered. At the end of the case or in the PACU, a catheter will be inserted and affixed mid-thigh to the skin using dermabond, steri-strips, and a chg tegaderm dressing. The catheter will be connected to the disposable pump filled with sterile saline (400 cc) and the flow rate will be set to 0. The pump will be enclosed in a carrier bag provided by the company. To ensure blinding, the carrier bag will be taped to prevent the patient from accessing it.

Locations

Country	Name	City	State
United States	Hospital for Special Surgery	New York	New York

Sponsors (1)

Lead Sponsor	Collaborator
Hospital for Special Surgery, New York

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Opioid consumption during 24-48 hour period	Patients will be asked to report their opioid consumption during the 24-48 hour time period after spinal induction. This data will be converted to morphine milligram equivalents (mme).	Post-operative day 1-2 (24-48 hours post spinal induction)
Secondary	Opioid consumption during post-anesthesia care unit (PACU) stay	Patients will be asked to report their opioid consumption during their stay in the post-anesthesia care unit. This data will be converted to morphine milligram equivalents (mme).	Day of surgery from PACU arrival until transfer to in-patient floor (up to 48 hours)