Clinical trial NCT05190120: Adductor Canal Block Versus Femoral Block on Pain and Quadriceps Strength
Official title: Effects of Ultrasound-guided Adductor Canal Block Versus Femoral Nerve Block on Pain and Quadriceps Strength After Ambulatory Knee Arthroscopic Surgery
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Anterior Cruciate Ligament Tear
Knee Meniscus Tear
Keywords: Knee arthroscopy
ACL reconstruction
Femoral block
Adductor Canal Block
Lead sponsor: University of California, San Francisco
Sponsor class: OTHER
First posted: 2022-01-13
Enrollment: 108
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: The purpose of this study is to compare the effects of a femoral nerve block vs. an adductor canal block on pain and quadriceps muscle strength for knee arthroscopy surgery.

Detailed description: Patients undergoing arthroscopic knee surgery (ACL and non-ACL surgery) typically receive an ultrasound-guided femoral nerve block or an adductor canal block in the pre-operative phase for post-operative pain control. While an effective method for post-operative analgesia, the femoral nerve block is associated with profound quadriceps weakness for the duration of the nerve block, which can impair ambulation, rehabilitation, and increase the risk of falls. The more distal adductor canal block, however, contains primarily sensory branches of the femoral nerve and has been been purported by small volunteer studies to provide equally effective analgesia with minimal motor block and quadriceps weakness (as compared to femoral nerve block).

The investigators will prospectively randomize patients undergoing knee arthroscopy at the UCSF Orthopaedic Institute to receive either a single-shot femoral nerve or adductor canal block pre-operatively after taking baseline measurements of quadriceps strength (quantified by maximum voluntary isometric contraction). The quadriceps muscle strength will be checked 20 minutes after the nerve block to assess strength. All patients will subsequently undergo a general anesthetic. The primary outcome variable will be post-block quadriceps strength as a percentage of baseline from pre-block values. Secondary outcome variables that will also investigated include: VAS pain score in the post anesthesia recovery unit and post-operative day 1, time to onset of sensory block, duration of nerve blockade, block performance time, patient satisfaction score, perioperative opioid use, perioperative analgesic consumption, incidence of paresthesias, number of needle passes, incidence of post-operative nausea, vomiting, constipation, and any other complications.

Eligibility criteria: Inclusion Criteria:

* American Society of Anesthesia I-III classification,
* Scheduled for arthroscopic knee surgery (meniscal debridement/repair, ACL reconstruction)

Exclusion Criteria:

* Age younger than 18 years
* Non-English speaking
* Any contraindication for regional anesthesia, such as allergy to local anesthetics or opioids, -Coagulopaty or severe thrombocytopenia
* Infection at puncture sites
* Pre-existing neuropathy in operative limb
* Need for post-operative nerve function monitoring
* Dementia
* Patient refusal
* High pre-operative opioid requirements

Primary outcomes:
measure: Change in quadriceps strength related to the nerve block
timeFrame: Baseline and 20 minutes after the block prior to surgery
Secondary outcomes:
measure: Numerical Pain score from 0-10
timeFrame: up to 24 hours
measure: Duration of nerve block
timeFrame: 8 to 24 hours
measure: Opioid Consumption reported at mg of morphine equivalence
timeFrame: 2 days
Other outcomes:
Locations:
city: San Francisco
country: United States
facility: UCSF Orthopedic Trauma Service
state: California
Study officials:
affiliation: University of California, San Francisco
name: Pedram Aleshi, MD
role: PRINCIPAL_INVESTIGATOR
References: