Adductor Canal Catheter vs Local Infiltration of Analgesia for Total Knee Arthroplasty

The study is a prospective, randomized controlled clinical trial comparing two methods of
postoperative analgesia following primary TKA. Eligible primary TKA patients must be ASA I -
III and require less than 20 mg oxycodone daily (or its equivalent). Exclusion criteria are:
allergy to anesthetics, contraindication to regional anesthesia, sensory/ motor disorder
involving operative limb, non-english speaking, ASA IV or greater, psychiatric or cognitive
disorders, incarceration, renal insufficiency with Cr > 2.0 and hepatic failure. When
patients agree to participate in the study the following data will be collected by the
research staff: ASA physical status, age, height, weight, gender, quantitative opiate use,
numeric pain score with visual descriptors, painDETECT score, WOMAC score and baseline Pain
Management Questionnaire. When designated through randomization, local infiltration of
analgesia will be placed intraoperatively by the surgeons, per usual protocol and patients
in the LIA group will receive sham adductor canal catheter. All ACC's for both study groups
will be placed postoperatively in the PACU. Those collecting data will be blinded from
identifying patients in the control group, as both groups will have ACC placed with same
technique. Potential risks for each procedure, which will be explained to the patient,
include: bleeding, local infection, local anesthetic toxicity in the form of seizure and
cardiac arrest and neuropathy. The preceding are commonly listed though infrequent
complications of both procedures. Continuous ultrasound will guide the placement of the ACC.
All adductor canal catheters will remain in for 72 hours. Pt from LIA group will be
discharged home with sham catheter with a saline infusion at 10 ml/hr via an ambulatory
pump. Patients in ACC group will be discharged with continuous adductor canal catheter
delivering ropivacaine 0.2% at 10 ml/hr via an ambulatory pump. Patients will be called
daily for pain diary results. As well as at 6-8 weeks postoperatively to collect painDetect
and WOMAC survey.

Inclusion Criteria:

- Age 40-85

- American Society of Anesthesiologists (ASA) Physical Status (PS) 1-3. • Undergoing
Unilateral, Primary, Total Knee Arthroplasty

- English as native language

Exclusion Criteria:

- Patient refusal

- History of opioid dependence

- Contraindication to peripheral nerve block • Pre-existing significant neuropathy