Clinical trial NCT04814303: Impact of Adductor Canal Block on Functional Recovery
Official title: Adductor Canal Block Versus Periarticular Infiltration Effect on Functional Outcome In Patients Undergoing Total Knee Replacement
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Total Knee Replacement
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2021-03-24
Enrollment: 200
Sex: ALL
Minimum age (years): 45
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: TKA involves extensive bone resection as well as soft tissue excision and therefore is associated with profound postoperative pain. Adequate analgesia after TKA is therefore considered paramount to facilitate early hospital discharge and effective functional recovery.

Detailed description: Osteoarthritis (OA) of the knee has become a major public health issue and imposes a significant healthcare burden and accounts for high annual hospitalizations. Chronic OA of the knee may lead to reduced physical fitness, mobility disability with a resultant increased risk of cardio-metabolic comorbidity and early mortality. Total knee arthroplasty (TKA) is indicated in severe cases to improve long-term pain and function. (1) TKA involves extensive bone resection as well as soft tissue excision and therefore is associated with profound postoperative pain. (2) Inadequate perioperative pain control may prolong hospitalization, hinder early rehabilitation, and is also a strong predictor of persistent pain beyond 3 months. (3) Adequate analgesia after TKA is therefore considered paramount to facilitate early hospital discharge and effective functional recovery. (4) The recently introduced adductor canal block (ACB) typically covers the anterio-medial aspect of the knee and preserves quadriceps function, which presumably enhances postoperative rehabilitation by allowing patients to actively participate in knee movement. The relative effectiveness of this ACB technique added to intrathecal morphine is limited to a single study (1) in which assessment of short-term functional recovery was done and dexamethasone was neither included in the LIA solution nor perineurally in the ACB. Thus, we hypothesize that adductor canal block as an adjunct to intrathecal morphine will have a better impact on functional recovery than peri-articular infiltration.

Eligibility criteria: Inclusion Criteria:

* American Society of Anesthesiologist class ( ASA) I - III
* BMI 18-35 kg/m2
* Scheduled for primary unilateral TKR

Exclusion Criteria:

* Known allergy to local anesthetics
* Contraindication to adductor canal block e.g. infection at the site of injection
* Contraindication to spinal anesthesia e.g. coagulopathy.
* Patients with pre-existing motor or sensory deficits in lower extremities.
* Patients who are morbidly obese (BMI≥35) because ultrasound-guided regional anesthesia could be technically difficult.
* Bilateral or revision total knee replacement
* Insulin or noninsulin-dependent diabetes mellitus.
* systemic corticosteroid use within 30-days of surgery

Primary outcomes:
measure: "Timed Up and Go" test (TUG)
timeFrame: 48 hours
Secondary outcomes:
measure: Visual analogue scale (VAS) at rest
timeFrame: 72 hours
measure: Visual analogue scale (VAS) at movement
timeFrame: 72 hours
measure: Time to first analgesic request
timeFrame: 72 hours
measure: Total analgesic consumption
timeFrame: 72 hours
Other outcomes:
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