Adductor Canal Block With Posterior Capsular Injection for Total Knee Replacement

Study Overview
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Brief Summary
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To compare early ambulation and ability to participate in rehabilitation in patients undergoing total knee replacement using two different nerve block techniques for pain control. The 2 methods are 1) Adductor canal block with posterior capsular injection 2) femoral nerve block with tibial nerve block

Detailed Description
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Early mobilization in the postoperative period is important to the success of surgery following total knee replacement. However, severe post-operative pain is an impediment to early implementation of rehabilitaion program. The use of femoral nerve block combined with tibial nerve block as part of a multimodal analgesic program provides effective pain control but causes weakness of the operative extremity preventing patients from bearing weight, exercising the leg and increasing the risk of falls thereby delaying early participation in rehabilitation. Adductor canal block is a new technique that has been described to provide pain control after total knee arthroplasty (1). The advantages of this block is that it could potentially minimize lower extremity weakness because the target nerve (saphenous nerve) blocked in this technique is a purely sensory nerve and does not provide any motor innervation to any muscle groups. Adductor canal block lends itself easily to providing prolonged analgesia because a perineural catheter can be inserted and the block maintained by a continuous infusion of dilute local anesthetic solution for days. A disadvantage of this method is that it may not provide adequate analgesia for posterior knee pain in the early postoperative period. By combining adductor canal block with ultrasound guided posterior and antero-medial knee injection, the posterior knee pain can be controlled effectively. Posterior and antero-medial knee injection of local anesthetic solution has been used as a method of controlling posterior knee pain after total knee arthroplasty (2).

Official Title
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Assessment of Early Ambulation and Participation in Rehabilitation Program in Patients Receiving Continuous Adductor Canal Block With Ultrasound Guided Posterior Capsular Knee Injection vs Continuous Femoral Nerve Block With Tibial Nerve Block Following Total Knee Replacement.

Conditions
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Pain, Osteoarthritis

Intervention / Treatment
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* Procedure: Canal Block and Capsular Injection
* Procedure: Femoral with Tibial Nerve Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients having primary, unilateral total knee arthroplasty ages 18 - 80 Exclusion Criteria: history of neurological disease neuropathy diabetes major systemic illness pregnancy chronic narcotic use allergy to local anesthetic solution or NSAIDS inability to give consent or cooperate with the study protocol BMI> 40

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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Femoral With Tibial Nerve Block<br>Continuous femoral nerve block with catheter and selective tibial nerve block in the popliteal fossa | Procedure: Femoral with Tibial Nerve Block<br>* Continuous femoral nerve block with 15 ml of ropivacaine 0.1% followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days after surgery combined with tibial nerve block in the popliteal fossa with ropivacaine 0.1% up to 15 ml.<br>|
| Experimental: Canal Block and Capsular Injection<br>Adductor canal block with a continuous catheter and ultrasound guided posterior capsular injection with local anesthetic solution. | Procedure: Canal Block and Capsular Injection<br>* Continuous Adductor canal block with 15-30ml of ropivacaine 0.1% with epinephrine 1:400,000 followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days post operatively. This is combined with ultrasound guided posterior capsular knee injection with 30 ml ropivacaine 0.1% with epinephrine 1:400,000.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ability to ambulate post operatively. | Ability to ambulate and perform tasks of the rehabilitation program and reach rehabilitation milestones after total knee arthroplasty. | Up to 3 days (72 hours) post surgery. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain scores at rest and with knee flexion. | Measures of pain score using numeric pain rating scale (0=no pain, 10=worst pain) completed by patient in recovery room and every 6 hours for a 72 hour period after discharge from recovery room. | Up to 3 days ( 72 hours) after surgery | 
| Pain Medication Consumption | Amount of opioid consumption post surgery for 72 hours. | Up to 3 days (72 hours) post surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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early ambulation, knee arthroplasty