Single Dose Adductor Canal Block vs SPANK Block for TKA

Study Overview
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Brief Summary
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This is a prospective, randomized control trial to compare SPANK block combined with adductor canal block to adductor canal block alone in treatment of post-operative pain after total knee arthroplasty. The primary outcome is pain control, which will be measured throughout the post-operative course using morphine equivalents of opioid analgesics used during the first 24 hours after surgery. Secondary outcomes include pain scores recorded at 4, 8, 12, 16, 20, and 24 hours post-operatively, cumulative pain score, incidence of post-operative nausea and vomiting, and extent of motor blockade. The study will aid in answering the question of whether SPANK block is an effective adjunct in preventing pain and decreasing opioid requirement after TKA.

Official Title
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Single Dose Adductor Canal Block With SPANK (Sensory Posterior Articular Nerves of the Knee) Block Compared to Single Dose Adductor Canal Block and Pain Control After Total Knee Arthroplasty

Conditions
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Osteo Arthritis Knee, Pain, Postoperative, Pain, Acute

Intervention / Treatment
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* Procedure: SPANK Block (Sensory Posterior Articular Nerves of the Knee)
* Procedure: Adductor Canal Block
* Drug: Ropivacaine Hcl 0.5% Inj Vil 30Ml
* Device: Pajunk sonoplex stim needle


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients between the ages of 40 and 80 years old undergoing total knee arthroplasty amenable to peripheral nerve block for perioperative analgesia. BMI <45 ASA class III or less Exclusion Criteria: Inability to sign consent form Allergy to medications used in the study Repeat surgery History of seizure disorder Simultaneous bilateral TKA History of substance abuse BMI >45 Opioid consumption of greater or equal to 30mg morphine equivalents per day Age <40 or >80 years old ASA IV or greater Inability to use a PCA Inability to access the intrathecal space Infection at the site of injection (either for spinal or PNB) INR greater than or equal to 1.4

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Adductor Canal Block Alone<br>Control arm to receive Adductor Canal Block without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidance | Procedure: Adductor Canal Block<br>* Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the knee<br>Drug: Ropivacaine Hcl 0.5% Inj Vil 30Ml<br>* Amide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. The drug itself is not being studied and the same concentration will be used in all participants.<br>Device: Pajunk sonoplex stim needle<br>* Echogenic needle used for ultrasound guided nerve blockade.<br>|
| Experimental: SPANK Block Plus Adductor Canal Block<br>Experimental arm to receive Adductor Canal Block plus SPANK Block (Sensory Posterior Articular Nerves of the Knee) without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidance into the adductor canal plus 20cc ropivacaine 0.5% injected into the posterior tissues of the knee | Procedure: SPANK Block (Sensory Posterior Articular Nerves of the Knee)<br>* Injection of local anesthetic into the tissues on the posterior aspect of the knee to provide sensory blockade of the articular nerves of the knee.<br>Procedure: Adductor Canal Block<br>* Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the knee<br>Drug: Ropivacaine Hcl 0.5% Inj Vil 30Ml<br>* Amide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. The drug itself is not being studied and the same concentration will be used in all participants.<br>Device: Pajunk sonoplex stim needle<br>* Echogenic needle used for ultrasound guided nerve blockade.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative Opioid Consumption | Amount of opioids used within the first 24 hours post-operatively, starting from when the patient leaves the operating room, measured in PO morphine equivalents | 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative Pain Scores | Verbal pain score measured via numerical rating scale from 1-10 at 4 hrs, 8 hrs, 12hrs, 16hrs, and 24 hours. | 4, 8, 12, 16, and 24 hours postoperatively | 
| Time to first opioid use | The amount of time measured from when the patient leaves the operating room to the time when they receive their first dose of any opioid medication. | 24 hours postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Adductor Canal Block, Regional Anesthesia, Total Knee Arthroplasty, SPANK Block