Pre vs Post Block in Total Knee Arthroplasty (TKA)

Study Overview
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Brief Summary
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The purpose of this project is to determine if a change in patient reported pain, nausea and vomiting after total knee arthroplasty can be observed with the substitution of a post operative adductor canal block for a preoperative adductor canal block in the current established peri-operative pain protocol and if these changes lead to a decrease in opioid consumption (in morphine equivalents).

Official Title
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Pre vs. Postoperative Adductor Canal Block for Total Knee Arthroplasty: Prospective Randomized Trial

Conditions
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Knee Osteoarthritis, Arthroplasty Complications, Postoperative Pain

Intervention / Treatment
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* Drug: Dexamethasone
* Drug: Acetaminophen
* Drug: Lyrica
* Drug: Celebrex
* Drug: Meloxicam
* Drug: Oxycodone
* Drug: Ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1- Patients 18 or older 2 - Patients undergoing primary total knee replacement at the University of Miami Hospital 3 - Patients that have capacity to provide medical consent Exclusion Criteria: All patients under the age of 18 Prisoners, uncontrolled diabetics, increased risk of bleeding, pregnant women, women planning on becoming pregnant in the next year, and women who think they might be pregnant. Patients with prior surgery or history of infection on the joint of interest. Patients on steroid preoperatively. Inability to provide medical consent. Patients with a history of significant unmitigated pain in parts of their body not including the knee the procedure is to be performed or a history of pain catastrophizing (the tendency to magnify the threat value of the pain stimulus and to feel helpless in the context of pain, and by a relative inability to inhibit pain-related thoughts in anticipation of, during or following a painful event) regarding pain anywhere in the body. Any condition that, in the opinion of the investigator, would compromise the well-being of the patient or the study or prevent the patient from meeting or performing study requirements will exclude the participant. Allergy to local anesthetic or any medication used in the standard protocol for joint replacement.

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Preoperative Adductor Canal Block Group<br>Participants in this group will receive the standard of care treatment for pain management for TKA including a preoperative adductor canal block. Participants will be in this group for up to 24 hours after surgery. | Drug: Dexamethasone<br>* Dexamethasone 10mg administered via IV once postoperatively within 24 hours for pain and swelling<br>Drug: Acetaminophen<br>* 1,000mg administered via tablet every 8 hours for pain during the first 1-2 weeks postoperatively<br>Drug: Lyrica<br>* Administered via tablet 75mg nightly for pain during the first 1-2 weeks postoperatively<br>Drug: Celebrex<br>* 200mg administered via tablet twice a day for pain and swelling during the first 1-2 weeks postoperatively<br>Drug: Meloxicam<br>* 30mg administered via IV once postoperatively within 24 hours for pain and swelling<br>Drug: Oxycodone<br>* 5mg administered via tablet every 4 hours as needed for pain during the first 1-2 weeks postoperatively<br>Drug: Ropivacaine<br>* 20 milliliters Ropivacaine 0.2% administered via injection perioperatively.<br>* Other names: Adductor Canal Block;|
| Experimental: Postoperative Adductor Canal Block Group<br>Participants in this group will receive the standard of care treatment for pain management after TKA, however, the adductor canal block will be placed postoperatively. Participants will be in this group for up to 24 hours | Drug: Dexamethasone<br>* Dexamethasone 10mg administered via IV once postoperatively within 24 hours for pain and swelling<br>Drug: Acetaminophen<br>* 1,000mg administered via tablet every 8 hours for pain during the first 1-2 weeks postoperatively<br>Drug: Lyrica<br>* Administered via tablet 75mg nightly for pain during the first 1-2 weeks postoperatively<br>Drug: Celebrex<br>* 200mg administered via tablet twice a day for pain and swelling during the first 1-2 weeks postoperatively<br>Drug: Meloxicam<br>* 30mg administered via IV once postoperatively within 24 hours for pain and swelling<br>Drug: Oxycodone<br>* 5mg administered via tablet every 4 hours as needed for pain during the first 1-2 weeks postoperatively<br>Drug: Ropivacaine<br>* 20 milliliters Ropivacaine 0.2% administered via injection perioperatively.<br>* Other names: Adductor Canal Block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in pain status as measured by Numeric Pain Scale | Likert Scale with numeric scores ranging from 0 (least) to 10 (most) pain | Baseline, up to 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients reporting vomiting | Count of patients reporting vomiting and number of episodes of vomiting | Up to 24 hours | 
| Number of patients reporting nausea | Count of patients reporting nausea and number of episodes of nausea | Up to 24 hours | 
| Duration of hospital stay | Count of time patient stays in hospital after surgery in hours | Up to 72 hours | 
| Total opioid consumption in the immediate post-operative period | Measure the amount of morphine milliequivalents consumed by patient | Up to 24 hours |