Pain Control for Anterior Cruciate Ligament Reconstruction Patients With Adductor Canal or Femoral Perineural Infusions

Study Overview
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Brief Summary
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Nerve blocks are used to provide pain control after moderately painful orthopedic surgeries. Anterior Cruciate Ligament (ACL) reconstruction with patellar autograft is a painful orthopedic procedure performed after traumatic injury to the knee. Many patients undergoing ACL reconstruction receive a nerve block as part of their anesthetic care. These blocks can be performed in different locations along the femoral nerve, with advantages and disadvantages to each location. Recently published evidence indicates that there is no short-term difference in pain control between the two commonly-targeted locations (Adductor Canal and Femoral). However, studies involving patients undergoing total knee arthroplasty indicate that femoral blocks provide better pain control with movement than adductor canal blocks. As many patients undergoing ACL reconstruction use continuous passive motion (CPM) machines as part of rehabilitation starting on post-operative day one, the investigators hypothesize that pain control and quality of recovery in the first 48 hours after surgery will be superior with a continuous femoral block than with a continuous adductor canal block. The investigators plan to study this by randomizing patients presenting for ACL reconstruction to receive either a continuous femoral or continuous adductor canal block (both considered adequate means of pain control), and following them to 48 hours to determine the level of pain, quality of recovery score, opioid use, and CPM compliance.

Detailed Description
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covery score, opioid use, and CPM compliance.

Official Title
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A Prospective Comparison of Pain and Quality of Recovery in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Adductor Canal or Femoral Perineural Infusions

Conditions
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Pain, Postoperative, Anterior Cruciate Ligament Injury

Intervention / Treatment
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* Procedure: Adductor Canal perineural catheter placement
* Procedure: Femoral Nerve perineural catheter placement
* Device: Nimbus pump (Infutronix)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients >18 years ASA physical status I, II, or III Scheduled for ACL reconstruction surgery with patellar autograft Exclusion Criteria: Pregnancy Incarceration Age <18 BMI >35 Pre-operative opioid use >15 mg morphine equivalents per day Inability to communicate with investigators by telephone Pre-existing neuropathy of the operative extremity

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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Adductor Canal Nerve Block group<br>Adductor Canal perineural catheter placement. Adductor Canal continuous perineural infusion. Ropivacaine 0.2% will be administered at a continuous rate of 5 mL/hour through a perineural catheter placed in the adductor canal. A Nimbus pump (Infutronix) will be delivering the medication. | Procedure: Adductor Canal perineural catheter placement<br>* Patients will receive an Adductor Canal Block intervention for pain control following ACL reconstructive surgeries.<br>* Other names: Adductor Canal block;Device: Nimbus pump (Infutronix)<br>* This is a FDA approved infusion device that is used in standard of care to store pain medication and to provide patients with continuous pain control medication at a set rate. This pump will be used for both the Adductor Canal and Femoral Nerve block participants.<br>|
| Active Comparator: Femoral Nerve Block group<br>Femoral Nerve perineural catheter placement. Femoral continuous perineural infusion. Ropivacaine 0.2% will be administered at a continuous rate of 5 mL/hour through a perineural catheter placed near the femoral nerve. A Nimbus pump (Infutronix) will be delivering the medication. | Procedure: Femoral Nerve perineural catheter placement<br>* Patients will have a Femoral perineural catheter placed for pain control following ACL reconstructive surgery.<br>* Other names: Femoral Nerve Block;Device: Nimbus pump (Infutronix)<br>* This is a FDA approved infusion device that is used in standard of care to store pain medication and to provide patients with continuous pain control medication at a set rate. This pump will be used for both the Adductor Canal and Femoral Nerve block participants.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Score | Participants will report pain on a numeric rating scale | Post-operative day 2 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Recovery | The Quality of Recovery 15 (QoR 15) is a 15-item questionnaire that is often used to assess how patients are doing in their post-operative course. This survey will be used to assess participants' quality of recovery after ACL reconstructive surgery. | POD 2 | 
| Opioid Use | Total morphine equivalents used through POD 2 | POD 2 | 
| CPM compliance | number of hours of reported CPM usage through POD 2 | POD 2 |