Epidural Catheter With or Without Adductor Canal Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | Any - 85 |
| Updated: | 4/2/2016 |
| Contact: | Min Lu, MD |
| Email: | lum@uchicago.edu |
| Phone: | 7735106129 |
The purpose of this study is to further investigate the efficacy of adductor canal nerve
blocks for pain management after total knee replacement. Specifically we are studying
adductor canal nerve blocks in conjunction with epidural anesthesia, which is a combination
that has not been extensively researched before. Our question is whether combining these
modalities will enhance patient satisfaction after surgery and accelerate patients'
readiness to discharge.
blocks for pain management after total knee replacement. Specifically we are studying
adductor canal nerve blocks in conjunction with epidural anesthesia, which is a combination
that has not been extensively researched before. Our question is whether combining these
modalities will enhance patient satisfaction after surgery and accelerate patients'
readiness to discharge.
Knee replacement surgery has become increasingly more common in the United States with
hundreds of thousands of surgeries performed yearly across the country. Despite that, there
is no consensus "standard of care" for optimum pain control regimen after surgery. Pain
management after TKA ranges from local tissue injections and patient controlled anesthesia
to regional nerve blocks to neuraxial anesthesia. Although regional anesthesia has become
more common and widespread, there are wide variations depending on practice setting
(academic versus private), equipment available (adductor nerve blocks require ultrasound
guidance), level of training of the anesthesiologists and patient selection, among other
factors. Another part of the reason for the wide variations in practice is the lack of
literature demonstrating clear effectiveness or superiority of one technique over another.
To date adductor canal nerve blocks have been mainly studied in comparison with femoral
nerve blocks in terms of their efficacy in controlling pain and their ability to preserve
motor function. Adductor canal nerve blocks have been shown in the literature to be an
effective method for postoperative pain control in total knee replacement surgery. One of
the unique benefits of this particular technique is that the adductor canal nerve block is
primarily a sensory block, thereby controlling pain without impairing motor strength. This
is useful for total knee replacement surgery as pain is controlled while quadriceps muscle
strength is preserved. With well functioning muscles patients are able to fully participate
in physical therapy with less strength impairment and reduced risk of falling.
It is our aim to investigate one multimodal approach that combines the strengths of two
proven pain management techniques and thereby improve overall postoperative pain control and
patient satisfaction. Our hope is to establish a protocol that is safe and effective for
patient care.
hundreds of thousands of surgeries performed yearly across the country. Despite that, there
is no consensus "standard of care" for optimum pain control regimen after surgery. Pain
management after TKA ranges from local tissue injections and patient controlled anesthesia
to regional nerve blocks to neuraxial anesthesia. Although regional anesthesia has become
more common and widespread, there are wide variations depending on practice setting
(academic versus private), equipment available (adductor nerve blocks require ultrasound
guidance), level of training of the anesthesiologists and patient selection, among other
factors. Another part of the reason for the wide variations in practice is the lack of
literature demonstrating clear effectiveness or superiority of one technique over another.
To date adductor canal nerve blocks have been mainly studied in comparison with femoral
nerve blocks in terms of their efficacy in controlling pain and their ability to preserve
motor function. Adductor canal nerve blocks have been shown in the literature to be an
effective method for postoperative pain control in total knee replacement surgery. One of
the unique benefits of this particular technique is that the adductor canal nerve block is
primarily a sensory block, thereby controlling pain without impairing motor strength. This
is useful for total knee replacement surgery as pain is controlled while quadriceps muscle
strength is preserved. With well functioning muscles patients are able to fully participate
in physical therapy with less strength impairment and reduced risk of falling.
It is our aim to investigate one multimodal approach that combines the strengths of two
proven pain management techniques and thereby improve overall postoperative pain control and
patient satisfaction. Our hope is to establish a protocol that is safe and effective for
patient care.
Inclusion Criteria:
- end stage degenerative joint disease
- enrolled for unilateral total knee arthroplasty at the University of Chicago
- age < 85
- ability to understand and willingness to sign a written informed consent
Exclusion Criteria:
- age > 85
- American Society of Anesthesiologists physical status > 3
- known hypersensitivity to lidocaine, bupivacaine, ropivacaine or other local
anesthetic agents
- Coagulopathy, specifically INR > 1.5, Platelets < 100, therapy with clopidogrel
within 5 days prior to surgery, enoxaparin or fondaparinux within the last 24 hours
prior to surgery, patients with anti-phospholipid syndrome requiring aggressive
anticoagulation perioperatively
- History of alcohol or substance abuse (including strong opioids - morphine,
oxycodone, methadone, fentanyl, ketobemidone), taking > 50 mg morphine equivalent
daily of opioids
- Pre-existing femoral neuropathy or radiculopathy
- Patients with poor ability to communicate
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