Adductor Canal Block With Posterior Capsular Injection for Total Knee Replacement

NCT ID: NCT01805661

Last Updated: 2015-03-17

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 56 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-03-31
• Study Completion Date: 2013-12-31

Brief Summary

To compare early ambulation and ability to participate in rehabilitation in patients undergoing total knee replacement using two different nerve block techniques for pain control. The 2 methods are 1) Adductor canal block with posterior capsular injection 2) femoral nerve block with tibial nerve block

Detailed Description

Early mobilization in the postoperative period is important to the success of surgery following total knee replacement. However, severe post-operative pain is an impediment to early implementation of rehabilitaion program. The use of femoral nerve block combined with tibial nerve block as part of a multimodal analgesic program provides effective pain control but causes weakness of the operative extremity preventing patients from bearing weight, exercising the leg and increasing the risk of falls thereby delaying early participation in rehabilitation. Adductor canal block is a new technique that has been described to provide pain control after total knee arthroplasty (1). The advantages of this block is that it could potentially minimize lower extremity weakness because the target nerve (saphenous nerve) blocked in this technique is a purely sensory nerve and does not provide any motor innervation to any muscle groups. Adductor canal block lends itself easily to providing prolonged analgesia because a perineural catheter can be inserted and the block maintained by a continuous infusion of dilute local anesthetic solution for days. A disadvantage of this method is that it may not provide adequate analgesia for posterior knee pain in the early postoperative period. By combining adductor canal block with ultrasound guided posterior and antero-medial knee injection, the posterior knee pain can be controlled effectively. Posterior and antero-medial knee injection of local anesthetic solution has been used as a method of controlling posterior knee pain after total knee arthroplasty (2).

Conditions

Pain; Osteoarthritis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Femoral With Tibial Nerve Block

Continuous femoral nerve block with catheter and selective tibial nerve block in the popliteal fossa

Group Type: ACTIVE_COMPARATOR

Femoral with Tibial Nerve Block

Intervention Type: PROCEDURE

Continuous femoral nerve block with 15 ml of ropivacaine 0.1% followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days after surgery combined with tibial nerve block in the popliteal fossa with ropivacaine 0.1% up to 15 ml.

Canal Block and Capsular Injection

Adductor canal block with a continuous catheter and ultrasound guided posterior capsular injection with local anesthetic solution.

Group Type: EXPERIMENTAL

Canal Block and Capsular Injection

Intervention Type: PROCEDURE

Continuous Adductor canal block with 15-30ml of ropivacaine 0.1% with epinephrine 1:400,000 followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days post operatively. This is combined with ultrasound guided posterior capsular knee injection with 30 ml ropivacaine 0.1% with epinephrine 1:400,000.

Interventions

Canal Block and Capsular Injection

Continuous Adductor canal block with 15-30ml of ropivacaine 0.1% with epinephrine 1:400,000 followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days post operatively. This is combined with ultrasound guided posterior capsular knee injection with 30 ml ropivacaine 0.1% with epinephrine 1:400,000.

Intervention Type: PROCEDURE

Femoral with Tibial Nerve Block

Continuous femoral nerve block with 15 ml of ropivacaine 0.1% followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days after surgery combined with tibial nerve block in the popliteal fossa with ropivacaine 0.1% up to 15 ml.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Patients having primary, unilateral total knee arthroplasty
• ages 18 - 80

Exclusion Criteria

• history of neurological disease
• neuropathy
• diabetes
• major systemic illness
• pregnancy
• chronic narcotic use
• allergy to local anesthetic solution or NSAIDS
• inability to give consent or cooperate with the study protocol
• BMI> 40

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Trinity Health Of New England

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Sanjay Sinha, M.D.

Role: PRINCIPAL_INVESTIGATOR

Saint Francis Hospital and Medical Center

Locations

Saint Francis Hospital and Medical Center

Hartford, Connecticut, United States

Countries

United States

Other Identifiers

12-10-002

Identifier Type: -

Identifier Source: org_study_id