Adductor Canal Nerve Block Following Total Knee Arthroplasty

Study Overview
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Brief Summary
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The purpose of this study is that an adductor canal nerve block (putting numbing medicine near the nerve) has been shown to produce excellent pain relief with less pain medication use after knee replacement surgery.The investigators will be comparing the amount of pain relief following knee replacement surgery when you have a nerve block in place. There will be approximately 66 subjects participating in this study. After surgery subjects will receive numbing medication every 6 hours for 48 hours. Subjects will also receive a morphine PCA (patient controlled analgesia) after surgery and pain medication by mouth every 4 hours around the clock with the option to receive more pain medication if needed. Subjects will participate in the study up to 3 days.

Official Title
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Adductor Canal Nerve Block Following Total Knee Arthroplasty: A Randomized, Prospective Study Comparing High vs. Low Volume Bolus of 0.33% Ropivacaine

Conditions
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Post-op Pain

Intervention / Treatment
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* Drug: Morphine PCA started at the end of surgery, 1 Percocet 1/325mg every 4 hours; may receive a second Percocet if needed.
* Drug: For the 30ml ropivacaine the intervention would be the subject can request extra pain medication which would be Percocet and/or morphine PCA.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Is the subject undergoing primary unilateral total knee arthroplasty? Is the subject 18 to 99 years of age? Is the subject ASA class 1, 2, or 3? Does the subject have a BMI less than 35? Can the subject consent in the English language? Exclusion Criteria: Does subject have an allergy to drugs used in this study; Does subject have a daily intake of opiate medications that are considered stronger than hydrocodone? Does subject have a history of alcohol or drug abuse Has subject had a previous total knee arthroplasty? Has subject had any neurologic deficits in the lower extremity being studied?

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 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: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 15ml ropivacaine<br>Depending on what dose of ropivacaine the subject is randomized to he/she could receive the 15ml dose injected into the catheter every 6 hours | Drug: Morphine PCA started at the end of surgery, 1 Percocet 1/325mg every 4 hours; may receive a second Percocet if needed.<br> <br> |
| Active Comparator: 30ml ropivacaine<br>If the subject is randomized to 30ml ropivacaine he/she will be injected through the catheter every 6 hours. | Drug: For the 30ml ropivacaine the intervention would be the subject can request extra pain medication which would be Percocet and/or morphine PCA.<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Opiate pain medication | At the end of the 48 hours period the total opiate pain medication taken will be collected and used for comparison as our primary outcome | The total amount of opiate pain medication will be recorded at 6 hour intervals for 48 hours after surgery. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient satisfaction with pain control | Secondary outcome measures will include demographic characteristics, pain scores, medication administration,patient satisfaction with pain control and any complications that may have arisen. We will also record the location of the adductor canal catheter on the final bolus dose. | We will look at the secondary outcome measure beginning every six hours for 48 hours after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Total knee arthroplasty, nerve block, Pain control after surgery