Incidence of Adductor Canal Catheter Dislodgment

Study Overview
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Brief Summary
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The goal of this observational study is to determine the incidence of dislodgement for adductor canal catheters after total knee arthroplasty on post-operative day 1. We will also attempt to identify factors associated with secondary catheter failure.

Detailed Description
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Total knee arthroplasty (TKA) is a common procedure for indications including osteoarthritis and malignancy involving the knee, with over 55,285 knee replacements performed between 2020-2021 in Canada. Ultrasound guided continuous adductor canal block (cACB) is the standard of care for postoperative analgesia for this procedure. The catheter is not always as effective at providing analgesia as would be expected - which could be due to displacement of the catheter. This displacement is most likely to occur peri-operatively or during physiotherapy post-operatively and as such, post-operative assessments can provide useful insight into causes of secondary failure. This prospective observational study aims to estimate the cACB dislodgment on POD 1 rate at a high volume, tertiary care referral centre, and identify factors associated with dislodgement and clinical sequelae. As this is an observational/QI study of the current standard of care at Sunnybrook Health Sciences Centre, anesthesiologists are free to use the cross sectional versus parallel insertion of the cACB per their discretion.

Official Title
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Positioning of Continuous Adductor Canal Catheters After Total Knee Arthroplasty

Conditions
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Total Knee Arthroplasty

Intervention / Treatment
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* Procedure: Adductor Canal Catheter


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for Total Knee Arthroplasty Older than 50 years Exclusion Criteria: Body Mass Index greater than 40 Chronic opioid consumption (greater than 30mg oral morphine equivalent daily) Contraindication to Adductor Canal Catheter

Ages Eligible for Study
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Minimum Age: 50 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Adductor Canal Catheter<br>Pre-operative adductor canal catheter placement | Procedure: Adductor Canal Catheter<br>* Ultrasound guided Adductor Canal Catheter for total knee arthroplasty analgesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adductor Canal Catheter tip in correct position on postoperative day 1 | Ultrasound confirmation of injectate spread adjacent to the femoral artery on postoperative day 1 (08h00) | Postoperative day 1 (08:00AM) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adductor Canal Catheter tip in correct position after insertion | Ultrasound confirmation of injectate spread adjacent to the femoral artery before surgery | Preoperative | 
| Sensory block | Loss of sensation in the saphenous nerve distribution on postoperative day 1 (08h00) | Postoperative day 1 (08:00AM) | 
| Postoperative opioid consumption (08h00) | Cumulative opioid consumption after total knee arthroplasty to postoperative day 1 (08h00) | Postoperative day 1 (08:00AM) | 
| Numeric Rating Scale for Pain (NRS) at rest on postoperative day 1 (08h00) | Maximum pain score on 0-10 Likert Scale | Postoperative day 1 (08:00AM) |