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
University of California, San Diego
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.
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 pe…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
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…
Interventions
- Devicecontinuous peripheral nerve block with OnQ pump
For continuous nerve blocks, the infusion pump that will be used are OnQ pumps (Avanos, Alpharetta, GA) and pre-filled with ropivacaine 0.2% and provided by UCSD's Investigational Drug Services.
- Drugsingle injection nerve block
An adductor canal single injection nerve block will be performed per standard of care. The adductor canal will be identified by ultrasound in the short-axis view. The distal aspect of the femoral triangle (and beginning of the adductor canal) will be identified distal to the mid-thigh in the ipsilateral limb. Using ultrasound guidance, a standard Tuohy block needle will be advanced through a skin wheal of lidocaine until its tip is in the hypoechoic area immediately distal saphenous nerve adjacent to the femoral artery. Twenty milliliters of ropivacaine 0.5% will be injected in divided doses with repeated negative aspiration.
Location
- University of California, San DiegoLa Jolla, California