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Total knee arthroplasty or replacement (TKA), a commonly performed surgery for osteoarthritis of the knee, is a painful procedure and requires a multimodal analgesic approach. A method for analgesia is local infiltration analgesia (LIA), where a mixture of drugs is injected around the knee joint.
Adductor canal block (ACB) is an alternative regional anaesthesia technique which has been shown to result in minimal thigh weakness.
The investigators aim to study if the analgesia provided by ACB is superior to LIA while preserving quadriceps strength.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Local Infiltration Analgesia | No Intervention | The Local Infiltration Analgesia group will receive local infiltration of ropivacaine 150mg, ketorolac 30mg, morphine 10mg, adrenaline 200mcg and vancomycin 500mg in a total volume of 75mls by the surgeon. | |
| Adductor Canal Block | Active Comparator | The Adductor Canal Block group of patients will receive intravenous ketorolac 30mg intra-operatively and an adductor canal block at the end of surgery. The block will be performed under real time ultrasound guidance and 30mls of 0.5% ropivacaine (150mg) is injected with a Stimuplex A100, 21G needle. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Adductor Canal Block | Procedure |
|
| Measure | Description | Time Frame |
|---|---|---|
| Morphine consumption in the first 24 hours | morphine consumption in the first 24 hours (including morphine administered in recovery and via PCA). | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Scores | Pain scores are recorded at 1, 6, 12, 24 and 48 hours post-operatively, assessed using a visual analog scale (0-100mm) at rest and during 45 degree passive flexion of knee. | 1, 6, 12, 24 hours; up to 48 hours postoperative |
| Morphine Consumption |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of Complications | Hematoma, wound infection, neurological deficits, any incidence of fall | up to 48 hours |
| Length of Hospital Stay | Number of days till discharge |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Yean Chin Lim, MBBS | Changi General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Changi General Hospital | Singapore | Singapore |
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The balance usage after primary outcome |
| At 48 hours |
| Postoperative Nausea and Vomiting | Presence/absence of nausea and vomiting, and total number of episodes of vomiting | Up to 48 hours |
| Sedation Scores | Up to 48 hours |
| Quadriceps Strength | at 24 and 48 hours |
| Up to 30 days |