Femoral Versus Adductor Canal Continuous Peripheral Nerve Blocks for Knee Arthroplasty
| Status: | Completed |
|---|---|
| Conditions: | Post-Surgical Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/8/2014 |
| Start Date: | December 2012 |
| End Date: | September 2014 |
Patients typically experience moderate-to-severe pain following knee arthroplasty that is
usually treated with a combination of oral and intravenous analgesics and enhanced by
continuous peripheral nerve blocks. There are currently two locations to place a perineural
catheter to provide analgesia following knee arthroplasty: a femoral nerve catheter and an
adductor canal catheter. Both have been demonstrated to be effective following knee
arthroplasty. However, it remains unknown if one location is superior to the other; or,
more accurately, what the relative benefits are to each technique.
While femoral CPNB has many benefits, one of the challenges of using this technique is that
there is a decrease in quadriceps muscle strength which can be a limiting factor for
rehabilitation. In contrast, the adductor canal catheter affects only the vastus medialis.
This block may lessen block-induced quadriceps weakness following knee arthroplasty compared
with a femoral infusion.
The investigators hypothesize that compared with femoral perineural local anesthetic
infusion, an adductor canal infusion is associated with a shorter time until four discharge
criteria are met: (1) adequate analgesia; (2) independence from intravenous analgesics; (3)
ability to ambulate 30 m; and (4) ability to stand, walk 3 m, and return to a sitting
position without another's assistance.
usually treated with a combination of oral and intravenous analgesics and enhanced by
continuous peripheral nerve blocks. There are currently two locations to place a perineural
catheter to provide analgesia following knee arthroplasty: a femoral nerve catheter and an
adductor canal catheter. Both have been demonstrated to be effective following knee
arthroplasty. However, it remains unknown if one location is superior to the other; or,
more accurately, what the relative benefits are to each technique.
While femoral CPNB has many benefits, one of the challenges of using this technique is that
there is a decrease in quadriceps muscle strength which can be a limiting factor for
rehabilitation. In contrast, the adductor canal catheter affects only the vastus medialis.
This block may lessen block-induced quadriceps weakness following knee arthroplasty compared
with a femoral infusion.
The investigators hypothesize that compared with femoral perineural local anesthetic
infusion, an adductor canal infusion is associated with a shorter time until four discharge
criteria are met: (1) adequate analgesia; (2) independence from intravenous analgesics; (3)
ability to ambulate 30 m; and (4) ability to stand, walk 3 m, and return to a sitting
position without another's assistance.
Of importance: The primary investigation involves 80 evaluable subjects (with primary
endpoint data) having tri-compartment knee arthroplasty. In addition, the investigators
will enroll up to 70 subjects having uni-compartment knee arthroplasty as a pilot study in
preparation for a subsequent larger, definitive trial. These two groups will not be
analyzed together--they represent two distinct studies: one a definitive RCT for
tri-compartment knee arthroplasty; and, one a pilot study for uni-compartment knee
arthroplasty.
endpoint data) having tri-compartment knee arthroplasty. In addition, the investigators
will enroll up to 70 subjects having uni-compartment knee arthroplasty as a pilot study in
preparation for a subsequent larger, definitive trial. These two groups will not be
analyzed together--they represent two distinct studies: one a definitive RCT for
tri-compartment knee arthroplasty; and, one a pilot study for uni-compartment knee
arthroplasty.
Inclusion Criteria:
1. primary, unilateral knee arthroplasty
2. age ≥ 18 years
3. postoperative analgesic plan includes perineural local anesthetic infusion of 48-72
hours
Exclusion Criteria:
1. morbid obesity as defined by a body mass index >40 (BMI=weight in kg/ [height in
meters]
2. chronic, high-dose opioid use (greater than 20mg oxycodone-equivalent opioid use
daily within the 2 weeks prior to surgery and duration of use >4 weeks)
3. history of opioid abuse
4. allergy to study medications
5. known renal insufficiency (creatinine > 1.5 mg/dL)
6. pregnancy
7. incarceration
8. any known neuro-muscular deficit of the ipsilateral femoral nerve, obturator nerve
and/or quadriceps muscle (including diabetic peripheral neuropathy); and inability to
ambulate 30 m preoperatively.
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