Ultrasound-guided Continuous Adductor Canal Block for Analgesia After Total Knee Replacement: Comparison of Short-axis and Long-axis Techniques

Study Overview
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Brief Summary
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This study compares the long-axis and short-axis technique of continues adductor canal block for total knee replacement surgery. Half participants will receive long-axis catheterization, while the other half will receive short-axis catheterization.

Conditions
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Total Knee Arthroplasty, Analgesia, Nerve Block

Intervention / Treatment
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* Procedure: ultrasound guided long axis placement of adductor canal catheter
* Procedure: ultrasound guided short axis placement of adductor canal catheter
* Device: Philip CX 50 Ultrasound Scanner
* Device: PAJUNK Contiplex S Catheter
* Drug: Ropivocaine
* Drug: rescue sulfentanil given postoperatively as PICA


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-80 years Knee-arthroscopy Written consent ASA I-III BMI 19-35 Exclusion Criteria: Unable to communicate with the investigators (e.g., a language barrier or a neuropsychiatric disorder). coagulopathy or on anticoagulant medication Allergic reactions toward drugs used in the trial History of substance abuse Infection at injection site Can not be mobilised to 5 meters of walk pre-surgery

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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: short axis (SAX) placement of adductor canal catheters<br>Procedure: Ultrasound guided short axis (SAX) placement of adductor canal catheters Philip CX50 ultrasound scanner guided insertion of a PAJUNK Contiplex S catheter along the short axis of the middle part of adductor canal | Procedure: ultrasound guided short axis placement of adductor canal catheter<br>* The long axis of the ultrasound probe is placed vertical to the long axis of the adductor canal while scanning, and the catheter is placed along the short axis of the canal using an in-plane approach<br>Device: Philip CX 50 Ultrasound Scanner<br>* The linear (C5-12) probe of Philip CX 50 Ultrasound Scanner is used for scanning<br>Device: PAJUNK Contiplex S Catheter<br> <br> Drug: Ropivocaine<br>* 0.2% ropivacaine 10ml is given as loading dose. Following that, 0.2% ropivacaine 5ml/h is given as maintenance dose.<br>Drug: rescue sulfentanil given postoperatively as PICA<br>* bolus: 2mg, lock time: 10min, 1h limitation: 8mg<br>|
| Experimental: long axis (LAX) placement of adductor canal catheters<br>Procedure: Ultrasound guided long axis (LAX) placement of adductor canal catheters Philip CX50 ultrasound scanner guided insertion of a catheter along the long axis of the middle part of adductor canal | Procedure: ultrasound guided long axis placement of adductor canal catheter<br>* The long axis of the ultrasound probe is placed parallel to the long axis of the adductor canal while scanning, and the catheter is placed along the long axis of the canal using an in-plane approach<br>Device: Philip CX 50 Ultrasound Scanner<br>* The linear (C5-12) probe of Philip CX 50 Ultrasound Scanner is used for scanning<br>Device: PAJUNK Contiplex S Catheter<br> <br> Drug: Ropivocaine<br>* 0.2% ropivacaine 10ml is given as loading dose. Following that, 0.2% ropivacaine 5ml/h is given as maintenance dose.<br>Drug: rescue sulfentanil given postoperatively as PICA<br>* bolus: 2mg, lock time: 10min, 1h limitation: 8mg<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the strength of quadriceps femoris | strength of quadriceps femoris measured on a Lovett muscle strength rating-scale within 48 hours after surgery | within 48hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative nausea and vomiting score | Rating-scale 0-3 SAX-group vs. LAX-group | 0-2, 2-4, 4-8, 8-24, 24-48 hours postoperative | 
| ambulation time | SAX-group vs. LAX-group | within the 7 days after surgery | 
| quality of recovery | use the self-assessment 11item QoR scale to assess the patient's recovery quality,SAX-group vs. LAX-group | 3days and 7days after surgery | 
| complications | Record complications including catheter dislodgment, puncture point infection, leakage,falling down,et al. | within the 7 days after surgery | 
| the strength of quadriceps femoris | SAX-group vs. LAX-group | 0,2,4,8,24,48 hours postoperative | 
| Pain-score (VAS), patient at rest | Pain-score measured on a Visual Analog Scale (VAS) .SAX-group vs. LAX-group | 0,2,4,8,24,48 hours postoperative | 
| Pain-score (VAS), motion pain | Pain-score measured on a Visual Analog Scale (VAS) .SAX-group vs. LAX-group | 0,2,4,8,24,48 hours postoperative | 
| sulfentanil consumption | record the amount（ml) of sulfentanil used | 0,2,4,8,24,48 hours postoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adductor canal block