Continuous Nerve Block for Post-Knee Replacement Pain

Overseen By Yehoshua Gleicher, MD, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Toronto

Must not be taking: Opioids

Disqualifiers: Alcohol, Drug dependency, Coagulopathy, others

Compensation: Varies

Number of Visits: 4

Duration: 60 hours

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you are using chronic opioids equivalent to 30mg of morphine daily, you would not be eligible to participate.

What data supports the effectiveness of the treatment Continuous adductor canal block (CACB) for post-knee replacement pain?

Research shows that continuous adductor canal block (CACB) is effective for managing pain after knee replacement surgery. It provides good pain relief and allows better movement compared to other methods like epidural analgesia and continuous femoral nerve block. ^{1 2 3 4 5}

Is continuous adductor canal block (CACB) safe for humans?

Research indicates that continuous adductor canal block (CACB) is generally safe for humans, with studies showing no procedure-related complications in patients undergoing knee surgery. ^{1 2 3 6 7}

How is the continuous adductor canal block treatment different from other treatments for post-knee replacement pain?

Continuous adductor canal block (CACB) is unique because it provides ongoing pain relief by continuously delivering medication near the saphenous nerve, unlike single-injection methods that offer temporary relief. This approach can improve pain management and mobility after knee replacement surgery compared to other nerve block techniques. ^{1 2 3 7 8}

What is the purpose of this trial?

Total knee arthroplasty (TKA) is a frequent performed surgery. Many institutions are implementing outpatient programs for this surgery and adequate pain management is an important feature. Analgesic duration of single shot nerve blocks is limited to no more than 24h. Conversely, the use of continuous nerve block (CNB) through a perineural catheter and infusion of local anesthetic may increase duration of analgesia and provide better outcomes. The purpose of this study is to evaluate effectiveness and safety of using CNB in patients undergoing primary TKA, and its effects on patients' quality of recovery. We hypothesize that continuous adductor canal block would lead to a better quality of recovery in patients undergoing primary TKA.

Research Team

Naveed Siddiqui, MD, MSc

Principal Investigator

University of Toronto

Eligibility Criteria

This trial is for patients over 21 years old who are having knee replacement surgery as outpatients and have a moderate risk of complications (ASA I-III). They should not be dependent on alcohol or drugs, understand the treatment process, and cannot be using strong painkillers regularly. People with allergies to study meds, blood clotting issues, low platelet counts, or problems where the catheter goes can't join.

Inclusion Criteria

I am older than 21 years.

My overall health is good to moderately impaired.

You don't have a problem with drinking too much alcohol or using drugs.

Exclusion Criteria

I was admitted to the hospital due to complications after surgery.

Your blood doesn't clot properly and your platelet count is too low.

I have been using opioids equivalent to 30mg of morphine daily for the past 2 weeks.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Pre-surgery Assessment

Pre anesthesia consult and study explanation, including consent form review

At least 2 days

1 visit (in-person)

Treatment

Patients undergo total knee arthroplasty with continuous adductor canal block or sham block

60 hours

1 visit (in-person)

Follow-up

Participants are monitored for catheter associated complications and quality of recovery

30 days

Phone follow-ups on Days 1, 2, 3, and 30

Treatment Details

Interventions

• Continuous adductor canal block (CACB)
• Sham continuous adductor canal block (ShACB)

Trial Overview The study tests if continuous adductor canal block (CACB), which involves infusing pain medication through a tube near nerves in the thigh, provides better pain control and recovery after outpatient knee surgery compared to a sham procedure without real medicine (ShACB).

Participant Groups

Group I: Continuous adductor canal block (CACB) Experimental Treatment 1 Intervention

Will receive an infusion of 0.2% ropivacaine 5mL/h through adductor canal catheter.

Group II: Sham continuous adductor canal block (ShACB). Placebo Group 1 Intervention

Will receive an infusion of NaCl 0.9% 5mL/h through adductor canal catheter.

Who Is Running the Clinical Trial?

University of Toronto

Lead Sponsor

Trials

739

Recruited

1,125,000+

MOUNT SINAI HOSPITAL

Collaborator

Trials

44

Recruited

17,000+

Findings from Research

In a study of 145 patients undergoing total knee arthroplasty, continuous adductor canal blocks (CACB) resulted in better ambulation and lower pain scores compared to epidural analgesia, indicating enhanced postoperative recovery.

Patients receiving CACB reported higher satisfaction rates (68% in general + CACB and 63% in spinal + CACB) compared to those receiving combined spinal-epidural analgesia (36%), suggesting that CACB may be a more favorable option for pain management in knee surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Continuous Adductor Canal Blocks Provide Superior Ambulation and Pain Control Compared to Epidural Analgesia for Primary Knee Arthroplasty: A Randomized, Controlled Trial. Kayupov, E., Okroj, K., Young, AC., et al.[2022]

In a study of 120 patients undergoing total knee arthroplasty, the combination of adductor canal block (ACB) and interspace between popliteal artery and capsule of posterior knee block (IPACK) provided significantly better pain relief compared to ACB alone, as measured by VAS scores.

Patients receiving the ACB+IPACK technique also demonstrated improved range of motion and ambulation distance post-surgery, indicating that this method enhances recovery without compromising motor function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Sankineani, SR., Reddy, ARC., Eachempati, KK., et al.[2022]

In a study of 57 total knee arthroplasty patients, both proximal and distal adductor canal blocks (ACBs) provided similar levels of postoperative pain relief, as indicated by comparable opioid consumption and pain scores.

While the proximal ACB group showed a trend towards better functional mobility (measured by the 'Up and Go' test), this difference was not statistically significant, suggesting that both techniques are equally effective for pain management post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Comparison of Pain Control and Functional Mobility between Proximal and Distal Adductor Canal Blocks for Total Knee Replacement. Romano, C., Lloyd, A., Nair, S., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Continuous versus single shot adductor canal block for postoperative pain relief after total knee arthroplasty: A protocol for randomized controlled trial. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of continuous adductor canal block versus continuous femoral nerve block in patients with total knee arthroplasty: A PRISMA guided systematic review and meta-analysis. [2023]

3. New Zealand pubmed.ncbi.nlm.nih.gov

Positioning the Catheter Tip Anterior or Posterior to the Saphenous Nerve in Continuous Adductor Canal Block: A Mono-Centric Retrospective Comparative Study. [2023]

4. China pubmed.ncbi.nlm.nih.gov

Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Continuous Adductor Canal Blocks Provide Superior Ambulation and Pain Control Compared to Epidural Analgesia for Primary Knee Arthroplasty: A Randomized, Controlled Trial. [2022]

6. Germany pubmed.ncbi.nlm.nih.gov

Intraoperative Surgeon-Performed versus Conventional Anesthesiologist-Performed Continuous Adductor Canal Block in Total Knee Arthroplasty: A Randomized Controlled Trial. [2023]

7. France pubmed.ncbi.nlm.nih.gov

Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. [2022]

8. India pubmed.ncbi.nlm.nih.gov

A Randomized Comparison of Pain Control and Functional Mobility between Proximal and Distal Adductor Canal Blocks for Total Knee Replacement. [2022]