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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.
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 perineural infusion of ropivacaine (0.2%) (experimental group); versus (2) single injection with ropivacaine (0.5%) of the adductor canal block and no continuous nerve block added.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Continuous adductor canal block | Experimental | single injection with ropivacaine (0.5%) of the adductor canal block and a 5-day continuous perineural infusion of ropivacaine (0.2%) (experimental group) |
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| single injection adductor canal block | Active Comparator | single injection with ropivacaine (0.5%) of the adductor canal block and no continuous nerve block added |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| continuous peripheral nerve block with OnQ pump | Device | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| analgesic effect of 5-day continuous nerve block of the adductor canal relative to a single inection nerve block with ropivacaine. | Numeric Rating Scale (NRS) for pain will be superior daily with continuous adductor canal blocks on postoperative days 1-7 following total ankle arthroplasty as compared with single-injection adductor canal blocks (as measured by the "average" daily NRS within the Brief Pain Inventory) | 7 days |
| opioid consumption of 5-day continuous nerve block of the adductor canal relative to a single inection nerve block with ropivacaine. | Opioid consumption will be superior daily with continuous adductor canal blocks on postoperative days 1-7 following total ankle arthroplasty as compared with single-injection adductor canal blocks (measured in oxycodone equivalents) | 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| physical and emotional functioning of 5-day continuous nerve blocks relative to a single injection nerve blocks with ropivacaine | The physical and emotional functioning of research participants will be superior daily with continuous adductor canal blocks on postoperative days 1-7 following total ankle arthroplasty as compared with single-injection adductor canal blocks (as measured with the Brief Pain Inventory Interference Subscale) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rodney A Gabriel, MD | Contact | 858-663-7747 | ragabriel@health.ucsd.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California, San Diego | Recruiting | La Jolla | California | 92037 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26827847 | Background | Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016 Feb;17(2):131-57. doi: 10.1016/j.jpain.2015.12.008. |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| single injection nerve block | Drug | 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. |
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| 7 days |
| improvement in physical therapy milestones of 5-day continuous nerve blocks relative to a single injection nerve blocks with ropivacaine | Knee injury and osteoarthritis outcome score for joint replacement (KOOS JR) | 30 days |
| 30-day pain score measured in Numeric Rating Scale | At around 30 days postoperatively, the patients average pain score measured in the numeric rating scale (0-10) will be assessed. | 30 days |
| 30-day postoperative opioid consumption | Around 30 days postoperatively, the average opioid consumption will be assessed. This will be based on the average opioid consumption over the preceding week at 30 days. | 30 days |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |