Does Adding an Additional Numbing Medication Injection in the Thigh Help With Pain Control After Knee Replacement Surgery?

Study Overview
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Brief Summary
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One common anesthetic that is performed for total knee replacement surgery is spinal anesthesia with an adductor canal regional block, which involves injecting numbing medication in the thigh region for pain control after surgery. The aim of this study is to determine whether the addition of another regional block called obturator nerve block, which involves injecting numbing medication in the upper thigh region, will improve pain control after surgery while not sacrificing mobility after surgery.

Detailed Description
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There is currently no consensus on the optimal strategy that provides the most effective postoperative analgesia while preserving ambulation and limiting side effects such as nausea and vomiting. The clinical team's hypothesis is that the obturator nerve block in addition to adductor canal block can target both the anterior and posterior distribution of nerves to the knee to provide superior analgesia while not limiting ambulation. To test this hypothesis, the clinical team will compare the rate of IV opioid consumption in patients who receive a combination of adductor canal block and obturator nerve block at the surgical site versus patients who receive adductor canal block alone.

Official Title
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Evaluating the Addition of Obturator Nerve Block to Adductor Canal Block for Total Knee Arthroplasty

Conditions
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Knee Osteoarthritis, Knee Rheumatism

Intervention / Treatment
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* Drug: Obturator nerve regional block
* Drug: Adductor canal regional block
* Drug: Saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled to undergo total knee arthroplasty Planned use of regional anesthesia for procedure Willing and able to provide informed consent Exclusion Criteria: Patients on immunosuppressive therapy Patients with history of diabetes Patients with lower limb neuropathy Patients with history of chronic opioid use for > 3 months, including but not limited to, fentanyl, morphine, oxycodone, methadone Patients with known allergy or intolerance to any drug used in the study Patients with history of alcohol or drug abuse Patients with history of intolerance of nonsteroidal anti-inflammatory drugs Patients with hepatic or renal insufficiency ASA score of 4 or greater

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
Interventional Model Description: Randomized controlled trial with two arms: one arm will receive adductor canal block and obturator nerve block with the local anesthetic bupivacaine; second arm will receive adductor canal block with bupivacaine and obturator nerve block with saline.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Investigational arm<br>Patients in this arm will receive adductor canal regional block with bupivacaine and obturator nerve regional block with bupivacaine | Drug: Obturator nerve regional block<br>* Obturator nerve regional block involves the injection of a local anesthetic called bupivacaine into the upper thigh.<br>* Other names: bupivacaine;Drug: Adductor canal regional block<br>* Adductor canal regional block, which involves injecting numbing medication in the thigh region for pain control.<br>|
| Sham Comparator: Control arm<br>Patients in this arm will receive adductor canal regional block with bupivacaine and obturator nerve regional block with saline | Drug: Adductor canal regional block<br>* Adductor canal regional block, which involves injecting numbing medication in the thigh region for pain control.<br>Drug: Saline<br>* Saline as placebo comparator<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine Equivalence Consumption | Total amount of opioids consumed | up to 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Score | Likert scale ranging from 0-10 - 0 being no pain, and 10 being the worst pain ever experienced | 1, 6, 12, and 24 hours after surgery | 
| Number of Participants With Nausea or Vomiting | Yes or No responses when the subject is asked if the subject is feeling nauseous or has vomited | up to 24 hours after surgery | 
| Time to Ambulation | The length of time that it takes before the patient is first able to walk with assistance after surgery as assessed by a physical therapist. | on postoperative day 1 after surgery | 
| Time to Breakthrough Pain Medication | Time before pain medication needed for breakthrough pain | up to post operative day 2 after surgery | 
| Analgesia Satisfaction Score | Analgesia Satisfaction Score - Full scale from 0-10 with higher score indicating higher satisfaction. | 2 weeks after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adductor canal regional block, obturator nerve regional block, total knee arthroplasty, knee replacement surgery, Knee rheumatoid arthritis