Intraoperative Direct vs Postoperative Ultrasound Guided Adductor Canal Nerve Block After Total Knee Arthroplasty

Knee Osteoarthritis Clinical Trial

Official title:

Intraoperative Direct Adductor Canal Nerve Block Versus Post Operative Ultrasound Guided Adductor Canal Nerve Block in Total Knee Arthroplasty: a Double-blind Randomized Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03733509
• Other study ID #: 180620002
• Status: Completed
• Phase: N/A
• Start date: November 12, 2018
• Est. completion date: October 24, 2022

Study information

• Verified date: October 2022
• Source: Pontificia Universidad Catolica de Chile
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study compares analgesic effect between two techniques of adductor canal nerve block after total knee arthroplasty. The first group of the patients will receive intraoperative adductor canal nerve block; and the other group post operative ultrasound guided adductor canal nerve block. Investigators will measure postoperative opioid consumption, pain management and rehabilitation goals.

Description:

Total knee arthroplasty (TKA) is a successful alternative to treat late stage knee osteoarthritis (OA). Pain management has been one of the main focuses of postoperative care. Most surgeons prefer a comprehensive multimodal approach including preoperative pharmacological treatment, intraoperative infiltration with complex drug mixes and postoperative peripheral nerve block.

The most common postoperative nerve block alternative is the proximal femoral nerve block (FNB) which has shown improvements on postoperative pain measured by reduced opioid consumption and decreased pain at rest. Its main detractors argue that the motor nerve block effect is deleterious to early ambulation and have promoted adductor canal nerve blocks (ACB). Described by Lund et al in 2011, ACB block main femoral pain sensory contributors to the knee (articular branches of obturator nerve, vastus medialis branch and saphenous nerve) but is more distal to most motor branches to the quadriceps allowing near to normal quadriceps strength.

Standard ACB block is performed under ultrasound guidance after surgery completion, still in the operating room (OR). Recent literature has shown the anatomic feasibility of intraoperative ACB via blunt suprapatellar dissection in standard medial parapatellar TKA approaches. The study seeks to determine the effectiveness of standard ultrasound guidance ACB compared with intraoperative ACB.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 121
• Est. completion date: October 24, 2022
• Est. primary completion date: May 12, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years and older

Eligibility

Inclusion Criteria:

• Primary total knee arthroplasty

• Unilateral

• American Society of Anesthesiologists (ASA) score I, II or III

• Accepts spinal anesthesia

Exclusion Criteria:

• General anesthesia

• Chronic kidney disease

• Drug or alcohol abuse

• Chronic opioid use

• Allergic to bupivacaine or similar

Related Conditions & MeSH terms

• Knee Osteoarthritis
• Nerve Block
• Osteoarthritis
• Osteoarthritis, Knee
• Total Knee Arthroplasty

Intervention

Procedure:
• Intraoperative Block
One shot adductor canal nerve block with 20ml of bupivacaine 0.25% through surgical incision
• Ultrasound Block
One shot adductor canal nerve block with 20ml of bupivacaine 0.25% mid-thigh
• Intraoperative Placebo
One shot adductor canal nerve infusion with 20ml of saline solution through surgical incision
• Ultrasound Placebo
One shot adductor canal nerve infusion with 20ml of saline solution mid-thigh

Locations

Country	Name	City	State
Chile	Pontificia Universidad Católica de Chile	Santiago	Región Metropolitana

Sponsors (1)

Lead Sponsor	Collaborator
Pontificia Universidad Catolica de Chile

Country where clinical trial is conducted

Chile, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	24 hour opioid consumption	Opioid consumption by patient controlled analgesia (PCA) and any other oral or IV analgesics	First 24 hours after surgery
Secondary	24 patient reported pain	Patient reported pain scale using visual analog scale (VAS) every 6 hours after surgery (0 hours, 6 hours, 12 hours, 18 hours and 24 hours)	First 24 hours after surgery
Secondary	Time up and go Test	Standardised test to determine patients ability to walk 24 hours after surgery	24 hours after surgery
Secondary	Time to Discharge	Time between surgery and patient in conditions for discharge: no IV requirements, basic walking capability and VAS pain score equal or below 3	7 days
Secondary	Range of motion	Active and passive knee range of motion	24 hours after surgery