Single Dose Adductor Canal Block vs SPANK Block for TKA

NCT ID: NCT03502889

Last Updated: 2019-04-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

128 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-06-30

Study Completion Date

2020-06-30

Brief Summary

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This is a prospective, randomized control trial to compare SPANK block combined with adductor canal block to adductor canal block alone in treatment of post-operative pain after total knee arthroplasty. The primary outcome is pain control, which will be measured throughout the post-operative course using morphine equivalents of opioid analgesics used during the first 24 hours after surgery. Secondary outcomes include pain scores recorded at 4, 8, 12, 16, 20, and 24 hours post-operatively, cumulative pain score, incidence of post-operative nausea and vomiting, and extent of motor blockade. The study will aid in answering the question of whether SPANK block is an effective adjunct in preventing pain and decreasing opioid requirement after TKA.

Detailed Description

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Conditions

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Osteo Arthritis Knee Pain, Postoperative Pain, Acute

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Adductor Canal Block Alone

Control arm to receive Adductor Canal Block without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidance

Group Type ACTIVE_COMPARATOR

Adductor Canal Block

Intervention Type PROCEDURE

Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the knee

Ropivacaine Hcl 0.5% Inj Vil 30Ml

Intervention Type DRUG

Amide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. The drug itself is not being studied and the same concentration will be used in all participants.

Pajunk sonoplex stim needle

Intervention Type DEVICE

Echogenic needle used for ultrasound guided nerve blockade.

SPANK Block Plus Adductor Canal Block

Experimental arm to receive Adductor Canal Block plus SPANK Block (Sensory Posterior Articular Nerves of the Knee) without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidance into the adductor canal plus 20cc ropivacaine 0.5% injected into the posterior tissues of the knee

Group Type EXPERIMENTAL

SPANK Block (Sensory Posterior Articular Nerves of the Knee)

Intervention Type PROCEDURE

Injection of local anesthetic into the tissues on the posterior aspect of the knee to provide sensory blockade of the articular nerves of the knee.

Adductor Canal Block

Intervention Type PROCEDURE

Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the knee

Ropivacaine Hcl 0.5% Inj Vil 30Ml

Intervention Type DRUG

Amide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. The drug itself is not being studied and the same concentration will be used in all participants.

Pajunk sonoplex stim needle

Intervention Type DEVICE

Echogenic needle used for ultrasound guided nerve blockade.

Interventions

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SPANK Block (Sensory Posterior Articular Nerves of the Knee)

Injection of local anesthetic into the tissues on the posterior aspect of the knee to provide sensory blockade of the articular nerves of the knee.

Intervention Type PROCEDURE

Adductor Canal Block

Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the knee

Intervention Type PROCEDURE

Ropivacaine Hcl 0.5% Inj Vil 30Ml

Amide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. The drug itself is not being studied and the same concentration will be used in all participants.

Intervention Type DRUG

Pajunk sonoplex stim needle

Echogenic needle used for ultrasound guided nerve blockade.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients between the ages of 40 and 80 years old undergoing total knee arthroplasty amenable to peripheral nerve block for perioperative analgesia.
* BMI \<45
* ASA class III or less

Exclusion Criteria

* Inability to sign consent form
* Allergy to medications used in the study
* Repeat surgery
* History of seizure disorder
* Simultaneous bilateral TKA
* History of substance abuse
* BMI \>45
* Opioid consumption of greater or equal to 30mg morphine equivalents per day
* Age \<40 or \>80 years old
* ASA IV or greater
* Inability to use a PCA
* Inability to access the intrathecal space
* Infection at the site of injection (either for spinal or PNB)
* INR greater than or equal to 1.4
Minimum Eligible Age

40 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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San Antonio Uniformed Services Health Education Consortium

FED

Sponsor Role lead

Responsible Party

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Angela Curell

Anesthesiology Resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Angela M Curell, MD

Role: PRINCIPAL_INVESTIGATOR

San Antonio Uniformed Services Health Education Consortium

Central Contacts

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Angela M Curell, MD

Role: CONTACT

(210) 220-7450

Gregory Stevens, MD

Role: CONTACT

(210) 916-2014

References

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Terkawi AS, Mavridis D, Sessler DI, Nunemaker MS, Doais KS, Terkawi RS, Terkawi YS, Petropoulou M, Nemergut EC. Pain Management Modalities after Total Knee Arthroplasty: A Network Meta-analysis of 170 Randomized Controlled Trials. Anesthesiology. 2017 May;126(5):923-937. doi: 10.1097/ALN.0000000000001607.

Reference Type BACKGROUND
PMID: 28288050 (View on PubMed)

Gao F, Ma J, Sun W, Guo W, Li Z, Wang W. Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. Clin J Pain. 2017 Apr;33(4):356-368. doi: 10.1097/AJP.0000000000000402.

Reference Type BACKGROUND
PMID: 27322397 (View on PubMed)

Wang D, Yang Y, Li Q, Tang SL, Zeng WN, Xu J, Xie TH, Pei FX, Yang L, Li LL, Zhou ZK. Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. Sci Rep. 2017 Jan 12;7:40721. doi: 10.1038/srep40721.

Reference Type BACKGROUND
PMID: 28079176 (View on PubMed)

Karlsen AP, Wetterslev M, Hansen SE, Hansen MS, Mathiesen O, Dahl JB. Postoperative pain treatment after total knee arthroplasty: A systematic review. PLoS One. 2017 Mar 8;12(3):e0173107. doi: 10.1371/journal.pone.0173107. eCollection 2017.

Reference Type BACKGROUND
PMID: 28273133 (View on PubMed)

Li D, Ma GG. Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016 Aug;24(8):2614-9. doi: 10.1007/s00167-015-3874-3. Epub 2015 Nov 26.

Reference Type BACKGROUND
PMID: 26611901 (View on PubMed)

Bauer MC, Pogatzki-Zahn EM, Zahn PK. Regional analgesia techniques for total knee replacement. Curr Opin Anaesthesiol. 2014 Oct;27(5):501-6. doi: 10.1097/ACO.0000000000000115.

Reference Type BACKGROUND
PMID: 25111605 (View on PubMed)

Pelt CE, Anderson AW, Anderson MB, Van Dine C, Peters CL. Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence? J Arthroplasty. 2014 Jun;29(6):1154-7. doi: 10.1016/j.arth.2014.01.006. Epub 2014 Jan 16.

Reference Type BACKGROUND
PMID: 24581899 (View on PubMed)

Baratta JL, Gandhi K, Viscusi ER. Perioperative pain management for total knee arthroplasty. J Surg Orthop Adv. 2014 Spring;23(1):22-36. doi: 10.3113/jsoa.2014.0022.

Reference Type BACKGROUND
PMID: 24641894 (View on PubMed)

Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, Patt ML, Goon AK, Lee YY, Ma Y, Yadeau JT. Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology. 2014 Mar;120(3):540-50. doi: 10.1097/ALN.0000000000000119.

Reference Type BACKGROUND
PMID: 24401769 (View on PubMed)

Wasserstein D, Farlinger C, Brull R, Mahomed N, Gandhi R. Advanced age, obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty. J Arthroplasty. 2013 Aug;28(7):1121-4. doi: 10.1016/j.arth.2012.08.018. Epub 2012 Dec 21.

Reference Type BACKGROUND
PMID: 23265274 (View on PubMed)

Feibel RJ, Dervin GF, Kim PR, Beaule PE. Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution. J Arthroplasty. 2009 Sep;24(6 Suppl):132-7. doi: 10.1016/j.arth.2009.04.008. Epub 2009 Jun 24.

Reference Type BACKGROUND
PMID: 19553071 (View on PubMed)

Other Identifiers

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SPANK Block

Identifier Type: -

Identifier Source: org_study_id

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