The Impact of Continuous Adductor Canal Block Versus Continuous Femoral Nerve Block on Rehabilitation After Total Knee Replacement

Study Overview
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Brief Summary
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Total knee replacement (TKR) is considered the most effective and safe method of radical treatment of late stages of knee osteoarthritis. A well-known problem of TKR is a severe postoperative pain syndrome, which is observed in more than 50% of patients. Femoral nerve block (FNB) is the gold standard for continuous postoperative analgesia after total knee replacement, as it is effective in reducing the frequency of use of opioid analgetics and reduce the duration of hospitalization. At the same time, the negative effect of this method is the motor blockade of the quadriceps femoris muscle which leads to functional impairment and is associated with an increased risk of falling. Adductor canal block (ACB) provides adequate analgesia comparable to femoral nerve block. Moreover, ACB doesn't affect the motor function of the quadriceps femoris muscle. The possibility of enhanced recovery after total knee replacement is the reason to compare continuous adductor canal block and continuous femoral nerve block.

Official Title
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The Impact of Continuous Adductor Canal Block Versus Continuous Femoral Nerve Block on Rehabilitation After Total Knee Replacement (AdORe - ACB)

Conditions
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Osteo Arthritis Knee, Gonarthrosis

Intervention / Treatment
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* Procedure: Continuous adductor canal block
* Procedure: Continuous femoral nerve block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 Planned primary total knee replacement Planned neuraxial anesthesia Written informed consent Exclusion Criteria: Urgent surgery Planned revision total knee replacement Known allergic reaction to anesthetics Confirmed localized infection at the puncture sites Confirmed localized tumor at the puncture sites Peripheral neuropathy of the lower extremities Parkinson's disease Previously enrolled in this trial

Ages Eligible for Study
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Minimum Age: 18 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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Continuous adductor canal block<br> | Procedure: Continuous adductor canal block<br>* Postoperative analgesia in this group will be carried out by continuous infusion of local anesthetics through a catheter installed in the region of the middle third of the adductor canal. Ropivacaine 0.2% solution will be used for postoperative analgesia. Local anesthetic infusion rate is 4 ml/h to 10 ml/h.<br>|
| Active Comparator: Continuous femoral nerve block<br> | Procedure: Continuous femoral nerve block<br>* Postoperative analgesia in this group will be carried out by continuous infusion of local anesthetics through a catheter installed to the femoral nerve in the area of the femoral triangle. Ropivacaine 0.2% solution will be used for postoperative analgesia. Local anesthetic infusion rate is 4 ml/h to 10 ml/h.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ambulation distance | Less meters means worse outcome | postoperative day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ambulation distance | Less meters means worse outcome | postoperative day 2 | 
| Timed up and go test | More seconds means worse outcome | postoperative day 1 | 
| Timed up and go test | More seconds means worse outcome | postoperative day 2 | 
| 10 meters walk test | More seconds means worse outcome | postoperative day 1 | 
| 10 meters walk test | More seconds means worse outcome | postoperative day 2 | 
| 30 seconds chair stand test | Less exercise done means worse outcome | postoperative day 1 | 
| 30 seconds chair stand test | Less exercise done means worse outcome | postoperative day 2 | 
| 5 times sit to stand test | More seconds means worse outcome | postoperative day 1 | 
| 5 times sit to stand test | More seconds means worse outcome | postoperative day 2 | 
| time to readiness to dicharge | time from the day of surgery to the day of readiness to discharge | 30 day | 
| length of hospitalization | time from the day of surgery to the day of discharge | 30 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Osteo Arthritis Knee, Gonarthrosis, Regional anesthesia, Analgesia, Postoperative analgesia, Total knee replacement, Continuous femoral nerve block, Femoral nerve block, Continuous adductor canal block, Adductor canal block