Ultrasound-guided Adductor Canal Block for Total Knee Replacement

Study Overview
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Brief Summary
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Total knee arthroplasty is associated with intense early postoperative pain. Fast track recovery programs including early therapy protocols and early hospital discharge are being implemented at various hospitals. The postoperative analgesic pain regimen should enhance functional recovery in addition to providing efficient analgesia with minimal side effects. Adductor canal blockade is commonly used to provide postoperative analgesia for total knee arthroplasty (TKA) surgery. The investigators hypothesize that an ultrasound guided adductor canal block will lower narcotic consumption and improved overall satisfaction compared to ultrasound guided sham block with normal saline (placebo) for patients undergoing minimally invasive TKA surgery.

Detailed Description
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The investigators hypothesize that an ultrasound guided adductor canal block will lower narcotic consumption and improved overall satisfaction compared to ultrasound guided sham block with normal saline (placebo) for patients undergoing minimally invasive TKA surgery.

Official Title
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Ultrasound-guided Adductor Canal Block for Total Knee Replacement: a Randomized, Double-blind Placebo Controlled Trial.

Conditions
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Complications; Arthroplasty, Knee Injuries

Intervention / Treatment
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* Drug: Bupivacaine
* Drug: Preservative free normal saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants 40 to 75 years old who are presenting for minimally invasive total knee arthroplasty under spinal anesthesia Exclusion Criteria: Patient refusal American Society of Anesthesiologists physical status classification of 4 or higher Pre-existing neuropathy in the femoral or sciatic distribution Coagulopathy Infection at the site Chronic opioid use (greater than 3 months) Pregnancy Medical conditions limiting physical therapy participation Any other contra-indication to regional anesthesia

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Active Group<br>Ultrasound-guided adductor canal blockade with 10 ml of 0.25% bupivacaine | Drug: Bupivacaine<br>* 10 ml of 0.25% bupivacaine<br>* Other names: Sensorcaine;|
| Placebo Comparator: Control Group<br>Ultrasound-guided sham block with 10 ml of preservative free normal saline | Drug: Preservative free normal saline<br>* 10 ml of preservative free normal saline<br>* Other names: 0.9% sodium chloride;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid Consumption (mg morEq) | Opioid consumption (morphine equivalents) | 36 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale Pain Score | Visual Analog Scale pain score; 0 = no pain, 10 = excruciating pain) in the knee recorded every 6 hours up to 36hrs following surgery. | Pain burden at 36hr | 
| Length of Hospitalization | The average time to discharge in hours. Participants were discharged home went physical therapy criteria were met. | 0 to 192 hours |