Clinical trial NCT06784882: Continuous Versus Single Injection Adductor Canal Blocks for Outpatient Total Knee Arthroplasty
Official title: A Pilot Randomized Controlled Trial Assessing Pain and Opioid Outcomes Among Patients Undergoing Total Knee Arthroplasty Receiving 5-Day Outpatient Adductor Canal Continuous Versus Single Injection Blocks
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE4
Conditions: Acute Postoperative Pain
Surgery
Keywords: regional anesthesia
total knee arthroplasty
nerve block
Lead sponsor: University of California, San Diego
Sponsor class: OTHER
First posted: 2025-01-20
Enrollment: 40
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a single-center pilot study to determine if an adductor canal continuous nerve block is superior to single injection nerve block following total knee arthroplasty. Investigators will randomize participants to either continuous nerve block or single injection nerve block for the adductor canal preoperatively. They will assess differences in pain (measured in numeric rating scale), opioid consumption, and physical therapy milestones from postoperative day 0 to 7.

Detailed description: Adductor canal blocks are standard care for postoperative analgesia following total knee arthroplasty. Adductor canal blocks involve depositing local anesthetic (ropivacaine) around the saphenous nerve at the location of the adductor canal on the ipsilateral thigh. At UCSD, the standard care is to perform single injection adductor canal blocks for research participants undergoing total knee arthroplasty prior to surgery in the preoperative waiting area.

Participants will be randomized to either: (1) single injection with ropivacaine (0.5%) of the adductor canal block AND a 5-day continuous perineural infusion of ropivacaine (0.2%) (experimental group); versus (2) single injection with ropivacaine (0.5%) of the adductor canal block and no continuous nerve block added.

Eligibility criteria: Inclusion Criteria:

1. Adult participants of at least 18 years of age
2. Undergoing a primary, unilateral, total knee arthroplasty
3. Planned single-injection adductor canal nerve block
4. Weight \> 50 kg (to minimize the risk of local anesthetic toxicity)

Exclusion Criteria:

1. chronic opioid or tramadol use: daily oxycodone equivalents \> 20 mg for \> 4 weeks
2. neuro-muscular deficit of the surgical limb
3. moderate pain (NRS \> 3) in an anatomic location other than the surgical site
4. planned hospital admission following surgery
5. history of opioid misuse
6. those who lack capacity to complete informed consent
7. inability to contact the investigators during the treatment period, and vice versa (e.g., lack of telephone access)
8. incarceration
9. pregnancy
10. allergy to amide local anesthetics

Primary outcomes:
measure: analgesic effect of 5-day continuous nerve block of the adductor canal relative to a single inection nerve block with ropivacaine.
timeFrame: 7 days
measure: opioid consumption of 5-day continuous nerve block of the adductor canal relative to a single inection nerve block with ropivacaine.
timeFrame: 7 days
Secondary outcomes:
measure: physical and emotional functioning of 5-day continuous nerve blocks relative to a single injection nerve blocks with ropivacaine
timeFrame: 7 days
measure: improvement in physical therapy milestones of 5-day continuous nerve blocks relative to a single injection nerve blocks with ropivacaine
timeFrame: 30 days
measure: 30-day pain score measured in Numeric Rating Scale
timeFrame: 30 days
measure: 30-day postoperative opioid consumption
timeFrame: 30 days
Other outcomes:
Locations:
city: La Jolla
country: United States
facility: University of California, San Diego
state: California
Study officials:
References:
citation: Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016 Feb;17(2):131-57. doi: 10.1016/j.jpain.2015.12.008.