Single Injection Adductor Canal Block vs Catheter for Total Knee Arthroplasty
Condition: Total Knee Arthroplasty
Intervention: Adductor canal block; Adductor canal block with dexamethasone; Adductor canal catheter; Bupivacaine; Fentanyl; Ropivacaine 0.5% Injectable Solution; Dexamethasone
Intervention description: Spinal anesthesia with 2-3 ml 0.5% bupivacaine and 0-20mcg of fentanyl. At the end of the case, the surgeon will infiltrate 30ml 0.5% ropivacaine peri-articularly. 20ml 0.5% ropivacaine in the adductor canal in PACU.; Spinal anesthesia with 2-3 ml 0.5% bupivacaine and 0-20mcg of fentanyl. At the end of the case, the surgeon will infiltrate 30ml 0.5% ropivacaine peri-articularly. 20ml 0.5% ropivacaine in the adductor canal along with 8mg dexamethasone IV in PACU.; Spinal anesthesia with 2-3 ml 0.5% bupivacaine and 0-20mcg of fentanyl. At the end of the case, the surgeon will infiltrate 30ml 0.5% ropivacaine peri-articularly. 20ml 0.5% ropivacaine and a catheter placed in PACU, with a continuous infusion of 0.2% ropivacaine started.; Used in spinal anesthetic; May or may not be used in spinal anesthetic; Local anesthetic to be used by surgeon as local infiltration and by anesthesiologist in adductor canal block.; To be given intravenously at time of nerve block to one of the study arms.
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; Fentanyl; Bupivacaine; Ropivacaine; BB 1101
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 180.0
Sex: All
Minimum age: 18 Years
Maximum age: 100 Years
Healthy volunteers: No

Summary:

      This study investigates single injection adductor canal block (ACB) with or without
      intravenous dexamethasone and adductor canal catheter for pain management of total knee
      arthroplasty. This is a non-inferiority trial seeking to determine whether single injection
      ACB with dexamethasone is "no worse" than a continuous catheter.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients over or equal to the age of 18 years old who can understand the study
             protocol and are able to give consent

          -  Patients with an American Society of Anaesthesiology (ASA) classification 1 to 3

          -  Patients must have a preoperative oral 24 hour opioid consumption of less than or
             equal to 30 mg morphine equivalents

          -  Patients must be able to understand and be able to use patient controlled analgesia

          -  Patients must be undergoing a primary total knee arthroplasty with neuraxial
             anesthesia

        Exclusion Criteria:

          -  Patients with a contraindication to neuraxial and/or regional anaesthesia

          -  Patients with an allergy to local anaesthetics

          -  Patients who have chronic pain not related to their knee joint

          -  Patients with chronic opioid use (daily or almost daily use >3 months)

          -  Patients with contraindications to dexamethasone (allergy, infection, Insulin
             dependent Diabetes Mellitus)

          -  Patients with pre-existing neuropathy

          -  Patients with hepatic failure

          -  Patients with renal failure with eGFR<60

          -  Patients with allergy to ketorolac or NSAIDs