Adductor Canal Block for Medial Compartment Knee Arthroplasty

Study Overview
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Brief Summary
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This study will evaluate the affects of a single injection ultrasound-guided adductor canal block for patients undergoing robotic-assisted (MAKOplasty) medial UKA (unicompartmental knee arthroplasty). Specifically, this study will compare the adequacy of postoperative analgesia provided by the adductor canal block with that provided by single injection lumbar plexus blockade. The working hypothesis is that the analgesia provided by the adductor canal block will be equivalent to the analgesia provided by the lumbar plexus block. The primary outcome will be a comparison of verbal numerical pain scores at rest and with movement over the first 24 hours following nerve blockade.

Official Title
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Evaluation of Ultrasound-Guided Adductor Canal Blockade for Postoperative Analgesia Following Robotic Medial Unicompartmental Knee Replacement

Conditions
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Postoperative Analgesia, Medial Unicompartmental Knee Arthroplasty

Intervention / Treatment
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* Drug: Adductor canal block
* Drug: Lumbar plexus block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 18-85 Undergoing unilateral robotic-assisted (MAKOplasty) medial compartment knee arthroplasty at Wake Forest University Baptist Medical Center. Must give written informed consent for anesthesia including subarachnoid blockade and peripheral nerve blockade of both the lumbar plexus and adductor canal. Must consent to the performance of a sham block at the site to which they are not randomized. Must also be reliable to give accurate verbal pain scores postoperatively. Exclusion Criteria: Contraindication to adductor canal blockade or lumbar plexus blockade (including significant coagulation abnormalities) History of opioid addiction or current chronic pain therapy for pain other than at the surgical site that is being treated with high-dose opioids (extended release opioids or > 40mg oxycodone equivalents per day) Allergy to study medications Failure to adequately place either the adductor canal or lumbar plexus blocks. Patients who decline or have a contraindication to subarachnoid blockade will also be excluded from the study. Pregnancy.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Adductor canal block<br>Patients in this arm will receive an adductor canal block prior to undergoing a medial compartment knee arthroplasty. | Drug: Adductor canal block<br> <br> * Other names: Saphenous nerve block;|
| Active Comparator: Lumbar plexus block<br>Patients in this arm will receive a lumbar plexus block prior to undergoing a medial compartment knee arthroplasty. | Drug: Lumbar plexus block<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Verbal Pain Scores at 6 Hours Post Nerve Blockade. | Comparison of verbal numerical pain scores at rest and with movement 6 hours following nerve blockade. The score range is 0-10 with higher scores denoting worse outcomes. | 6 hours post block. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid Consumption | Comparison of cumulative opioid consumption over 24 hour period between adductor canal block and lumbar plexus block. | 6, 12, 18, and 24 hours | 
| Time to First Analgesic | Time to first analgesic between two groups: adductor canal block and lumbar plexus block. | 24 hours | 
| Opioid Related Side Effects | Occurrence of opioid related side effects (nausea, vomiting and pruritus) between two groups: adductor canal block and lumbar plexus block. | 6, 12, 18, and 24 hours | 
| Quadriceps Motor Strength | Comparison of quadriceps motor strength at 6 hour post nerve block between two groups: adductor canal block and lumbar plexus block. The score range is 0-5, with higher scores denoting better outcomes. | 6 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Partial knee replacement