Effectiveness of a Femoral Block Following Total Knee Arthroplasty (TKA)

Study Overview
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Brief Summary
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Hospital stays after total joint replacement surgery have been getting shorter over the past 10 years. This is mostly due to new ways to manage pain and early rehabilitation. To be able to go home safely soon after surgery, patients need to: 1) have adequate pain control 2) be able to move through activities of daily living on their own (using aids) Femoral nerve block, in combination with pain medications, is one of the new treatment strategies that are currently being used at other hospitals in Canada, the United States and the United Kingdom. Nerve blocks involve a needle filled with local anesthetic into the nerve that allows the feeling of pain around the knee. With good pain management, patients will be able to more quickly bend their knee and regain the ability to walk with aids and move from sitting and lying positions to standing and walking. Once they can do these activities with adequate pain control, they can be discharged from hospital to continue recovery at home. The purpose of this study is to examine a new way of managing postoperative pain and encourage early knee flexion and mobility, while maintaining pain control for patients after total knee replacement. We believe that patients who receive the nerve block in addition to the regular pain medication will have more knee flexion at discharge and experience less pain than patients who only receive usual pain medications.

Official Title
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A Pilot Study of the Feasibility of Early Discharge After Total Knee Arthroplasty Using a Femoral Nerve Block

Conditions
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Total Knee Arthroplasty

Intervention / Treatment
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* Procedure: Femoral Block
* Other: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Undergoing primary total knee arthroplasty English-speaking Preoperative knee ROM > 90 degrees Body Mass Index < 40 Exclusion Criteria: Regular preoperative opioid use Hepatic insufficiency Any contra-indications to receiving a femoral block
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: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Femoral Block<br>Those receiving femoral block in addition to usual pain management | Procedure: Femoral Block<br>* Those receiving femoral block postoperatively<br>|
| Active Comparator: Usual Care<br>Those receiving only usual pain management without a femoral block | Other: Usual Care<br>* Those receiving only usual pain management postoperatively<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| knee flexion |  | at hospital discharge or day 4 postoperatively, whichever is earlier | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain |  | daily in hospital, 2 weeks, 6 weeks, 12 weeks | 
| length of hospital stay |  | during hospitalization | 
| nausea/vomiting |  | during hospitalization | 
| participation in rehabilitation |  | day of surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Total Knee, Range of Motion, Pain