Comparison of Regional Anesthesia Techniques After Total Knee Arthroplasty

Study Overview
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Brief Summary
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Comparison of continuous adductor canal block to continuous femoral nerve block in patients after total knee arthroplasty. All patients will be anesthetized with spinal anesthesia. Continuous infusion of ropivacaine with a catheter implemented to the adductor canal or next to the femoral nerve. The observed goals: pain intensity, the beginning and quality of rehabilitation.

Detailed Description
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Written consent will be obtained a day before the surgery. Only subarachnoidally anaesthetised patients may participate in the study. Pencil-point spinal needle and bupivacaine (Marcaine Heavy Spinal 0.5 %) will be used. Before the beginning of operation, under ultrasound control, a catheter will be implemented to one of the chosen position: the adductor canal (the middle or lower third of thigh) or near the femoral nerve (below the inguinal ligament). The local anesthetic solution of 0.2 % ropivacaine will be started with an elastomeric pump (5 mL per hour, up to 72 hours) as soon as a catheter in the right position. The pain will be measured with VAS (visual-analogue scale) 8, 24 and 48 hours after the end of operation, and at the discharge. At the same time, i.e.: 8, 24 and 48 hours from the end of surgery, the range of flexion and extension in the operated knee will be assessed. Moreover, the possibility of patient's sitting, standing up and walking will be noted. All parameters will be reassessed before patients' discharge from the hospital. Each patient will receive paracetamol (1.0) and metamizol (1.0) intravenously (i.v.) q6h. 5 mg of morphine may be given as required, up to 2 dosages per day as a rescue medication.

Official Title
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Continuous Adductor Canal Block in Comparison to Continuous Femoral Nerve Block in Patients After Total Knee Arthroplasty: Randomized Control Trail

Conditions
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Pain, Acute, Knee Arthropathy, Postoperative Pain, Mobility Limitation

Intervention / Treatment
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* Procedure: continuous anesthesia of adductor canal
* Procedure: continuous anesthesia of femoral nerve
* Procedure: Spinal anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: knee arthroplasty obtained consent subarachnoid anaesthesia Exclusion Criteria: coagulopathy allergy to to local anesthetics depression, antidepressant drugs treatment epilepsy usage of painkiller before surgery addiction to alcohol or recreational drugs

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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
Interventional Model Description: Two groups of patients randomly allocated: adductor canal group or femoral nerve group
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: continuous anesthesia of adductor canal<br> | Procedure: continuous anesthesia of adductor canal<br>* After subarachnoid anesthesia, but before the beginning of surgery, a catheter will be implemented to the adductor canal and infusion of 5 mL/h of 0.2 % ropivacaine will be started.<br>Procedure: Spinal anesthesia<br>* Before the beginning of surgery all patients will be anesthetised with 0.5 % hyperbaric bupivacaine (Marcaine Heavy), 2.0 - 2.5 mL solution. Pencil point spinal needle will be used.<br>* Other names: Subarachnoid anesthesia;|
| Experimental: continuous anesthesia of femoral nerve<br> | Procedure: continuous anesthesia of femoral nerve<br>* After subarachnoid anesthesia, but before the beginning of surgery, a catheter will be implemented next to the femoral nerve (below inguinal ligament) and infusion of 5 mL/h of 0.2 % ropivacaine will be started.<br>Procedure: Spinal anesthesia<br>* Before the beginning of surgery all patients will be anesthetised with 0.5 % hyperbaric bupivacaine (Marcaine Heavy), 2.0 - 2.5 mL solution. Pencil point spinal needle will be used.<br>* Other names: Subarachnoid anesthesia;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption | Total consumption of intravenous morphine by patients with the use of patient-controlled analgesia pump | 24 hours from the end of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knee flexion | range of flexion in operated knee | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | 
| Walking | Possibility of walking by patients at scheduled time points | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | 
| The change of acute postoperative pain | Measured with VAS (visual-analogue scale) | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | 
| Sitting | Possibility of walking by patients at scheduled time points | 8, 24, 48 hours from the end of surgery, and at the patient discharge from the hospital (an average 4-6 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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regional anesthesia, knee replacement, pain treatment, rehabilitation