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| Name | Class |
|---|---|
| St. Joseph's Healthcare Hamilton | OTHER |
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To assess feasibility of a a trial investigation postoperative patient-reported quality of recovery after total knee arthroplasty (TKA) with periarticular joint injection (PAI) ± single shot adductor canal block with or without adductor canal catheter infusion.
Knee osteoarthritis (KOA) is a leading cause of chronic knee pain and disability, with a lifetime prevalence of 45%. Treatment for symptomatic KOA includes physical therapy, oral anti-inflammatory medications and intra-articular steroid injections, with total knee arthroplasty (TKA) (or knee replacement) as the definitive treatment. Acute postoperative pain is common after TKA, leading to increased opioid consumption and increased hospital length of stay. Pain control following TKA has been investigated with interventions such as intrathecal morphine, nerve blocks, and periarticular joint injection (PAI). PAI and adductor canal block are well-established techniques used both in combination or in isolation in the management of postoperative pain for patients undergoing TKA. The aim of this study is to assess postoperative patient-reported quality of recovery after TKA with PAI and single shot adductor canal block with or without adductor canal catheter infusion.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| cACB active | Experimental | Periarticular joint injection (medication) + single shot adductor canal block (medication) + adductor canal catheter infusion (medication) |
|
| cACB sham | Placebo Comparator | Periarticular joint injection (medication) + single shot adductor canal block (medication) + adductor canal catheter infusion (normal saline) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ropivacaine | Drug | 800 mg ropivacaine in continuous infusion adductor canal block (400 mL total volume) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Recovery-15 Survey scores | Patient-reported Quality of Recovery scores, where higher scores indicate better quality of recovery | Postoperative day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Recovery-15 Survey scores | Patient-reported Quality of Recovery scores, where higher scores indicate better quality of recovery | Postoperative days 10 and 42 |
| Brief Pain Inventory - Pain Interference scores |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St Joseph's Healthcare Hamilton | Hamilton | Ontario | L8N 4A6 | Canada |
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| ID | Term |
|---|---|
| D000077212 | Ropivacaine |
| D000077330 | Saline Solution |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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Randomized control trial
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Pharmacy will have access to the randomization scheme. All other members of the study team are blinded.
| Normal saline | Drug | 400 mL normal saline in continuous infusion adductor canal block (400 mL total volume) |
|
On a scale of 0-10, where 0=Does not interfere and 10=Completely interferes, Patients will rate how much their pain interferes with: General activity, Mood, Walking ability, Normal work including housework, Relations with other people, Sleep, and Enjoyment of life
| Postoperative days 1, 2 and 3 in the morning |
| Pain Numerical Rating Scale at rest | Patient-reported pain measured on an 11-point scale from 0 [no pain] to 10 [worst pain imaginable] | Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 |
| Pain Numerical Rating Scale with activity | Patient-reported pain measured on an 11-point scale from 0 [no pain] to 10 [worst pain imaginable] | Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 after physiotherapy |
| Functional Recovery: Range of motion | Flexion and Extension range of motion measured in degrees | Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 after physiotherapy |
| Functional Recovery: Time to reach discharge criteria | Physiotherapist to assess when patient meets discharge criteria (measured in half days) | Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 after physiotherapy |
| Functional Recovery: Timed Up and Go test | Time it takes for patient to stand up from sitting in a chair, walk 3 meters, then turn and walk back to chair and sit down, measured in seconds | Postoperative day 42 |
| Frequency of opioid-related side effects (vomiting and nausea) | Number of vomiting events or complaints of nausea noted in nursing notes | Up to 3 days |
| Narcotic consumption in hospital | total amount and route of administration collected from routine and PRN opioid use in PACU and on surgical floor - measured in mg of oral morphine equivalence | Up to 3 days |
| Narcotic consumption at home | Post-discharge opioid consumption will be tracked with pill count on POD 1 or 2, 3 POD10 (± 2 days), and POD42 (± 2 days); on POD 42 - patient to show study nurse how many pills remain to ensure reporting accuracy | Postoperative day 42 |
| Complications | i. return to hospital once discharged for non-analgesic reasons ii. require more pain medications outside of prescription given | Postoperative days 10 and 42 |
| D000588 |
| Amines |
| D000077324 | Crystalloid Solutions |
| D007552 | Isotonic Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |