Enhanced Recovery After Surgery (ERAS) Total Knee Replacement (TKR) With a Transitional Pain Service

Expanding the Peri-operative Surgical Home Model: ERAS TKR With a Transitional Pain Service (TeleTPS)- Continuous Adductor Canal Catheter Versus Adductor Canal Block for Total Knee Arthroplasty, a Randomized Double-blind Controlled Trial

A comparison of two anesthetic techniques for total knee replacements: (1) Peri-Articular Injection (PAI), local infiltration between the popliteal artery and capsule of the knee block (IPACK) and single-shot adductor canal block (ACB) vs. (2) PAI, IPACK and continuous adductor canal block catheter (ACC).

Patients will be randomized to one of two groups: one group will receive a PAI, IPACK and single-shot adductor canal block; one group will receive PAI, IPACK and continuous adductor canal block catheter.

Inclusion Criteria:

• Patients with osteoarthritis scheduled for a primary total knee arthroplasty with a participating surgeon
• Planned use of regional anesthesia
• Ability to follow study protocol
• English speaking (secondary outcomes include questionnaires validated in English only)
• Lives within one hour of the hospital
• Has a smart phone

Exclusion Criteria:

• Hepatic or renal insufficiency
• Younger than 18 years old or older than 65 years ol
• Patients undergoing general anesthesia
• Allergy or intolerance to one of the study medications
• BMI >40
• Diabetes
• American Society of Anesthesiologists (ASA) status III or IV
• Chronic gabapentin/pregabalin use (regular use for longer than 3 months)
• Patients with chronic pain (from a referral to chronic pain service) or a pain catastrophizing scale (PCS >30)
• Patients with severe valgus deformity or flexion contracture
• Patients unable to follow home catheter instructions and unwilling to go home with an infusing catheter
• Patients who have no home caregivers in the event that a catheter is to be sent home with the patient
• Patients with planned stay at rehab facility (to avoid medical device being tampered with at the rehab facility)
• Non-English speakers (secondary outcomes include questionnaires validated in English only)