Acute Pain Clinical Trial
Official title:
Continuous Adductor Canal Block in Outpatient Total Knee Arthroplasty
Total knee arthroplasty (TKA) is a frequent performed surgery. Many institutions are implementing outpatient programs for this surgery and adequate pain management is an important feature. Analgesic duration of single shot nerve blocks is limited to no more than 24h. Conversely, the use of continuous nerve block (CNB) through a perineural catheter and infusion of local anesthetic may increase duration of analgesia and provide better outcomes. The purpose of this study is to evaluate effectiveness and safety of using CNB in patients undergoing ambulatory TKA, and its effects on patients' quality of recovery. We hypothesize that continuous adductor canal block would lead to a better quality of recovery in patients undergoing outpatient TKA.
Status | Recruiting |
Enrollment | 56 |
Est. completion date | December 31, 2024 |
Est. primary completion date | September 3, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 21 Years and older |
Eligibility | Inclusion Criteria: - Patients undergoing unilateral primary TKA in the outpatient setting. - Patients older than 21 years of age. - American Society of Anesthesiologists (ASA) physical status I-III. - No alcohol or drug dependency. - Sufficient understand and co-operation about the perineural catheter. Exclusion Criteria: - Perioperative complication or discharge delay leading to hospital admission. - Chronic opioid use of morphine 30mg equivalent per day for last 2 consecutive weeks. - Allergy to the study medications. - Coagulopathy and platelet count < 105/µL. - Patients with contraindications to the insertion of an epidural or adductor canal catheter (severe anatomic abnormalities or history of previous surgery at the site of catheter placement). |
Country | Name | City | State |
---|---|---|---|
Canada | Mount Sinai Hospital | Toronto | Ontario |
Lead Sponsor | Collaborator |
---|---|
University of Toronto | MOUNT SINAI HOSPITAL |
Canada,
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Hanson NA, Lee PH, Yuan SC, Choi DS, Allen CJ, Auyong DB. Continuous ambulatory adductor canal catheters for patients undergoing knee arthroplasty surgery. J Clin Anesth. 2016 Dec;35:190-194. doi: 10.1016/j.jclinane.2016.07.022. Epub 2016 Aug 30. — View Citation
Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg. 2010 Dec;111(6):1552-4. doi: 10.1213/ANE.0b013e3181fb9507. Epub 2010 Oct 1. — View Citation
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Leung P, Dickerson DM, Denduluri SK, Mohammed MK, Lu M, Anitescu M, Luu HH. Postoperative continuous adductor canal block for total knee arthroplasty improves pain and functional recovery: A randomized controlled clinical trial. J Clin Anesth. 2018 Sep;49:46-52. doi: 10.1016/j.jclinane.2018.06.004. Epub 2018 Jun 8. — View Citation
Myles PS. More than just morbidity and mortality - quality of recovery and long-term functional recovery after surgery. Anaesthesia. 2020 Jan;75 Suppl 1:e143-e150. doi: 10.1111/anae.14786. — View Citation
Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D. Knee replacement. Lancet. 2018 Nov 3;392(10158):1672-1682. doi: 10.1016/S0140-6736(18)32344-4. — View Citation
Sankineani SR, Reddy ARC, Eachempati KK, Jangale A, Gurava Reddy AV. Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol. 2018 Oct;28(7):1391-1395. doi: 10.1007/s00590-018-2218-7. Epub 2018 May 2. — View Citation
Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010 Jan;468(1):135-40. doi: 10.1007/s11999-009-1025-1. Epub 2009 Aug 13. — View Citation
Sun C, Zhang X, Song F, Zhao Z, Du R, Wu S, Ma Q, Cai X. Is continuous catheter adductor canal block better than single-shot canal adductor canal block in primary total knee arthroplasty?: A GRADE analysis of the evidence through a systematic review and meta-analysis. Medicine (Baltimore). 2020 May;99(20):e20320. doi: 10.1097/MD.0000000000020320. — View Citation
Yu R, Wang H, Zhuo Y, Liu D, Wu C, Zhang Y. Continuous adductor canal block provides better performance after total knee arthroplasty compared with the single-shot adductor canal block?: An updated meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020 Oct 23;99(43):e22762. doi: 10.1097/MD.0000000000022762. — View Citation
* Note: There are 11 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Quality of Recovery 15 score (QoR-15) | Quality of Recovery 15 score (QoR-15): from 0 to 150. Higher scores mean a better outcome. | Day 3 | |
Secondary | Pain scores | Numerical Rating Scale for pain (0=no pain at all; 10=worst pain) | Day 1 | |
Secondary | Pain scores | Numerical Rating Scale for pain (0=no pain at all; 10=worst pain) | Day 2 | |
Secondary | Pain scores | Numerical Rating Scale for pain (0=no pain at all; 10=worst pain) | Day 3 | |
Secondary | Pain scores | Numerical Rating Scale for pain (0=no pain at all; 10=worst pain) | Day 7 | |
Secondary | Pain scores | Numerical Rating Scale for pain (0=no pain at all; 10=worst pain) | Day 30 | |
Secondary | Pain scores | Numerical Rating Scale for pain (0=no pain at all; 10=worst pain) | Day 90 | |
Secondary | Opioid usage | Daily opioid usage in oral morphine equivalent doses | Day 1 | |
Secondary | Opioid usage | Daily opioid usage in oral morphine equivalent doses | Day 2 | |
Secondary | Opioid usage | Daily opioid usage in oral morphine equivalent doses | Day 3 | |
Secondary | Opioid usage | Daily opioid usage in oral morphine equivalent doses | Day 7 | |
Secondary | Opioid usage | Daily opioid usage in oral morphine equivalent doses | Day 30 | |
Secondary | Opioid usage | Daily opioid usage in oral morphine equivalent doses | Day 90 |
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