Clinical trial NCT06701175: Knee Arthroscopy for Pain Control
Official title: Anterolateral Geniculate Nerve Block and Portal Anesthesia in Knee Arthroscopy for Pain Control: a Randomized Control Trial
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Knee Arthroscopy
Lead sponsor: University of Alabama at Birmingham
Sponsor class: OTHER
First posted: 2024-11-22
Enrollment: 72
Sex: ALL
Minimum age (years): 19
Maximum age (years): 89
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SINGLE_GROUP
Intervention model description: Patients indicated for knee arthroscopy
Primary purpose: TREATMENT

Brief summary: This study aims to determine the effectiveness of an anterolateral genicular nerve block and portal anesthesia in controlling pain in the perioperative period after knee arthroscopy. Opioid consumption, the use of non-opioid medications, complication rate, and sleep quality will also be measured.

Detailed description: Orthopaedic surgeries are some of the most painful operations to recover from, especially when involving cruciate ligaments. Because of this, orthopaedic surgeons have worked to optimize postoperative pain management that provides the best relief. Opioids traditionally were the primary medication for pain control during the perioperative period, however, with the current opioid epidemic and opioids being the leading cause of accidental deaths in the United States, physicians have transitioned to multimodal pain control which has shown to provide better pain control. In cases involving knee arthroscopy, pain management options include variations of nerve blocks, medications, surgical techniques, and postoperative activity.

An anterolateral genicular nerve block has been proposed that focuses on decreasing postoperative pain in the lateral aspect of the knee by targeting the lateral retinacular nerve, the nerve to the vastus lateralis, and the articular branch of the nerve to the vastus intermedius. Adductor canal blocks and intraarticular injections are known methods of providing postoperative pain control, but due to their risks, they may be inappropriate for knee arthroscopy. An anterolateral geniculate nerve block targets sensory, terminal nerve fibers outside the joint capsule, theoretically avoiding the risks of large nerve irritation and chondrotoxicity. Postoperative portal injections are another form of analgesia provided after knee arthroscopy and have been demonstrated to be equally effective in controlling pain as intraarticular injections one hour postoperatively. Otherwise, portal injections in knee arthroscopy have not been extensively studied in the literature.

Patients will be sent home after surgery with a survey to be completed at 2, 4, 6, 12, 24, and 48 hours and 1 week. The survey will inquire about the period from the prior survey to the current survey and will evaluate pain via Visual Analog Score, opioid consumption, non-opioid medication use, sleep, and intervention complications. Patients will be called at 12 and 48 hours and 1 week as reminders to complete the survey.

Eligibility criteria: Inclusion Criteria:

* skeletally mature patients with indications for knee arthroscopy

Exclusion Criteria:

* include patients with previous knee surgery on the operative side
* opioid use within six weeks before surgery that is deemed to be chronic or excessive
* gabapentin use within six weeks before surgery
* diagnosis of chronic pain, fibromyalgia, or other somatosensory disorder(s)
* history of radicular pain or neuropathy in the operative limb
* patients with cancer

Primary outcomes:
measure: Postoperative Pain Management
timeFrame: 2, 4, 6, 12, 24, and 48 hours and 1 week post-op
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
References:
citation: Townshend D, Emmerson K, Jones S, Partington P, Muller S. Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the knee: a prospective, randomised double-blinded trial. J Bone Joint Surg Br. 2009 May;91(5):601-3. doi: 10.1302/0301-620X.91B5.21932.
citation: Ghodki PS, Shalu PS, Sardesai SP. Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia. J Anaesthesiol Clin Pharmacol. 2018 Apr-Jun;34(2):242-246. doi: 10.4103/joacp.JOACP_172_17.
citation: Howell R, Hill B, Hoffman C, Treacy E, Mulcahey MK. Peripheral Nerve Blocks for Surgery About the Knee. JBJS Rev. 2016 Dec 6;4(12):e1. doi: 10.2106/JBJS.RVW.16.00003.
citation: Tyler TF, McHugh MP, Gleim GW, Nicholas SJ. The effect of immediate weightbearing after anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1998 Dec;(357):141-8. doi: 10.1097/00003086-199812000-00019.
citation: Chunduri A, Aggarwal AK. Multimodal Pain Management in Orthopedic Surgery. J Clin Med. 2022 Oct 28;11(21):6386. doi: 10.3390/jcm11216386.
citation: Paul RW, Szukics PF, Brutico J, Tjoumakaris FP, Freedman KB. Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review. Arthrosc Sports Med Rehabil. 2021 Dec 17;4(2):e721-e746. doi: 10.1016/j.asmr.2021.09.011. eCollection 2022 Apr.
citation: Meissner W, Mescha S, Rothaug J, Zwacka S, Goettermann A, Ulrich K, Schleppers A. Quality improvement in postoperative pain management: results from the QUIPS project. Dtsch Arztebl Int. 2008 Dec;105(50):865-70. doi: 10.3238/arztebl.2008.0865. Epub 2008 Dec 12.