Total Knee Arthroplasty Utilizing Adductor Canal Block: Effect on Quadriceps Sparing

Postoperative Pain Management Following Total Knee Arthroplasty Utilizing Adductor Canal Block: Effects on Pain Management and Quadriceps Sparing

The purpose of this study is to investigate whether there is quantitative motor-sparing of the quadriceps muscles following adductor canal nerve block versus femoral nerve block. Patients will be randomly placed into one of three treatment groups: 1) Femoral nerve block, 2) Adductor canal nerve block - low volume, or 3) Adductor canal nerve block - high volume. Quadriceps function will be assessed in the operating room using a skin patch and electrical stimulation. Follow up visits with the patients will continue over the course of 2 days during patient's stay at the hospital. A total of 60 patients will be enrolled for the study.

Inclusion Criteria:

• All patients undergoing primary unilateral total knee arthroplasty
• Planned use of combined spinal epidural (CSE) anesthesia
• Ability to follow study protocol

Exclusion Criteria:

• Contraindication to a spinal or epidural anesthetic
• Chronic opioid use (defined as daily or almost daily use of opioids for >3 months)
• Allergy to local anesthetics
• Pre-existing neuropathy or weakness of the operative limb
• Any neuromuscular disorder
• Diabetes type I and II
• Contraindication to a femoral nerve block or adductor canal nerve block
• Allergy or intolerance to any of the study medications
• BMI > 35 kg/m2