Daily Single Shot Adductor Canal Block Versus Continuous Adductor Canal Block After Total Knee Arthroplasty

Study Overview
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Brief Summary
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This study will compare the analgesic efficacy of daily single-shot adductor canal block(ABC) versus continuous ACB after total knee arthroplasty (TKA).

Detailed Description
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Patients 19-75 years old, of ASA classification I-III scheduled for unilateral TKA, will be enrolled and randomized into two groups, single-shot ACB group and continuous ACB group. In both groups, participants will be administered a single-shot ACB immediately after the end of the operation. The single-shot ACB group will receive two separate single-shot ACBs, on the first and second postoperative day. A nerve block catheter will be placed in patients in the continuous ACB group, which will be connected to a patient-controlled analgesia pump until the second postoperative day. The primary outcome of this study is the average NRS pain score at rest from the end of surgery to 2 days after surgery.

Official Title
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Analgesic Efficacy of Daily Single Shot Adductor Canal Block Versus Continuous Adductor Canal Block After Total Knee Arthroplasty

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: Single shot adductor canal block
* Procedure: Continuous adductor canal block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA classification I, II, III Patients scheduled for unilateral knee arthroplasty Exclusion Criteria: Anesthesia other than spinal anesthesia Chronic opioid use Uncontrolled diabetes of HbA1c>7.5 Neuromuscular pathology of the ipsilateral leg Second-look knee arthroplasty Inability to communicate (e.g. dementia) Hypersensitivity to ropivacaine BMI > 40 Pregnancy

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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 |
| --- | --- |
| Experimental: Single shot adductor canal block<br> | Procedure: Single shot adductor canal block<br>* Single shot adductor canal block on the the first and second postoperative day.<br>|
| Active Comparator: Continuous adductor canal block<br> | Procedure: Continuous adductor canal block<br>* A catheter will be placed in the adductor canal and connected to a continuous patient-controlled analgesia pump.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average NRS pain score at rest | average of numerical rating scale (0: no pain, 10: worst imaginable pain) pain scores from 8 time points during 48h (+4h, +8h, +12h from end of surgery, 6AM, 2PM, 10PM of postoperative day 1, and 6AM and 2PM of postoperative day 2) | first 48h after end of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score at rest at +4h from end of surgery |  | +4h from end of surgery | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score during movement at +4h from end of surgery |  | +4h from end of surgery | 
| NRS pain score at rest at +8h from end of surgery |  | +8h from end of surgery | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score during movement at +8h from end of surgery |  | +8h from end of surgery | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score at rest at +12h from end of surgery |  | +12h from end of surgery | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score during movement at +12h from end of surgery |  | +12h from end of surgery | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score at rest at 6AM on postoperative day 1 |  | 6AM on postoperative day 1 | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score during movement at 6AM on postoperative day 1 |  | 6AM on postoperative day 1 | 
| NRS pain score at rest at 2PM on postoperative day 1 |  | 2PM on postoperative day 1 | 
| NRS pain score during movement at 2PM on postoperative day 1 |  | 2PM on postoperative day 1 | 
| NRS pain score at rest at 10PM on postoperative day 1 |  | 10PM on postoperative day 1 | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score during movement at 10PM on postoperative day 1 |  | 10PM on postoperative day 1 | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score at rest at 6AM on postoperative day 2 |  | 6AM on postoperative day 2 | 
| NRS pain score during movement at 6AM on postoperative day 2 |  | 6AM on postoperative day 2 | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score at rest at 2PM on postoperative day 2 |  | 2PM on postoperative day 2 | 
| numerical rating scale (0: no pain, 10: worst imaginable pain) pain score during movement at 2PM on postoperative day 2 |  | 2PM on postoperative day 2 | 
| Posteoperative opioid administration in morphine equivalents |  | from end of surgery to 48h after surgery | 
| Incidence of catheter tip dislocation | The catheter tip is considered to be dislocated if the catheter tip is located outside the adductor canal | at 2PM on postoperative day 1 and 2 | 
| Incidence of extravasation from catheter insertion site |  | at 2PM on postoperative day 1 and 2 | 
| Incidence of sleep disturbance due to pain |  | from end of surgery to postoperative day 2 | 
| Incidence of numbness of anterior thigh area |  | at 2PM on postoperative day 1 and 2 | 
| Strengh of quadratus femoris muscle (unit: kgf) |  | at 2PM on postoperative day 1 and 2 | 
| Incidence of falls during hospital stay |  | from end of surgery to 48h after surgery | 
| Postoperative range of motion of knee joint |  | at 2PM on postoperative day 1 and 2 |