Adductor Canal Blocks for Knee Arthritis

Overseen By Sanjula Costa

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ottawa Hospital Research Institute

Must not be taking: Opioids, Intrathecal morphine

Disqualifiers: Cirrhosis, Renal insufficiency, Neuropathy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 1 day

80 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you have used opioid pain medication within four weeks of the procedure.

What data supports the effectiveness of the treatment Adductor Canal Block for knee arthritis?

Research shows that Adductor Canal Block (ACB) is effective for pain control after knee surgeries like total knee arthroplasty, helping to manage pain while preserving muscle strength, which is important for recovery and mobility. ^{1 2 3 4 5}

Is the adductor canal block (ACB) safe for humans?

The adductor canal block (ACB) is generally considered safe for humans, as it is a common technique used to manage pain after knee surgeries. It is designed to provide pain relief while preserving muscle strength, and studies have not highlighted significant safety concerns. ^{1 2 3 5 6}

How is the adductor canal block treatment different from other treatments for knee arthritis?

The adductor canal block (ACB) is unique because it targets specific nerves in the leg to provide pain relief after knee surgery, like knee arthroplasty, while preserving muscle strength, unlike the femoral nerve block which can weaken the quadriceps muscle. ^{1 3 4 5 7}

What is the purpose of this trial?

Adductor canal blocks (ACB) have been recommended in total knee arthroplasty (TKA) to provide better control of post-operative pain, facilitate early ambulation, and reduce length of stay in the hospital. ACB is typically done before surgery by an anesthesiologist, which may increase time per case, cost, and requires the specialized skills of an anesthesiologist trained in regional anesthesia. Recent studies have suggested that surgeons can safely and reliably administer the adductor canal blocks (sACB) during surgery. However, there is currently very limited data on the clinical efficacy of such sACBs, and no studies assessing this technique in the context TKA that are discharged the same day. As such, this randomized control trial (RCT) is being done to compare sACBs to conventional anesthesiologist-performed adductor canal blocks (aACB).

Research Team

Simon Garceau, MD

Principal Investigator

The Ottawa Hospital

Eligibility Criteria

This trial is for men and women over 18 years old who are scheduled for same-day discharge total knee arthroplasty (TKA) due to osteoarthritis. It's not specified who can't join, but typically those with other major health issues or allergies to anesthesia might be excluded.

Inclusion Criteria

My knee replacement surgery is scheduled as a same-day discharge.

I have been diagnosed with osteoarthritis.

Exclusion Criteria

Inability or refusal to sign informed consent form

I cannot communicate in English or French and do not have a translator.

I am allergic to pain relief medications.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo total knee arthroplasty with either anesthesiologist-performed or surgeon-performed adductor canal blocks

1 day

1 visit (in-person)

Immediate Post-operative

Participants are monitored for pain, recovery, and discharge readiness

Up to 24 hours

Continuous monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

2 weeks

2 visits (in-person)

Treatment Details

Interventions

• aACB
• sACB

Trial Overview The study is testing two ways of managing pain during knee surgery: surgeon-administered adductor canal blocks (sACB) versus the traditional method done by anesthesiologists (aACB). The goal is to see if sACBs are as effective when patients go home the same day after surgery.

Participant Groups

Group I: Surgeon-Performed Adductor Canal Block (sACB) Experimental Treatment 1 Intervention

Patients will get an intra-operative adductor canal block performed by the surgeon

Group II: Anesthesiologist-Performed Adductor Canal Block (aACB) Active Control 1 Intervention

Patients will get a pre-operative adductor canal block performed by an anesthesiologist.

aACB is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Adductor Canal Block for:

• Total knee arthroplasty
• Knee arthroscopy
• Anterior cruciate ligament reconstruction
• Lower leg, foot, and ankle surgery

Approved in United States as Adductor Canal Block for:

• Total knee arthroplasty
• Knee arthroscopy
• Anterior cruciate ligament reconstruction
• Lower leg, foot, and ankle surgery

Approved in Canada as Adductor Canal Block for:

• Total knee arthroplasty
• Knee arthroscopy
• Anterior cruciate ligament reconstruction
• Lower leg, foot, and ankle surgery

Who Is Running the Clinical Trial?

Ottawa Hospital Research Institute

Lead Sponsor

Trials

585

Recruited

3,283,000+

Canadian Orthopaedic Foundation

Collaborator

Trials

15

Recruited

1,900+

Findings from Research

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]

Patients receiving a Continuous Proximal Adductor Canal Block (PACB) after total knee arthroplasty consumed significantly less morphine compared to those receiving a Continuous Epidural (CSE), indicating better pain management with PACB.

The PACB group not only had lower opioid consumption but also showed improved participation in physical therapy and shorter hospital stays, suggesting enhanced recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is continuous proximal adductor canal analgesia with a periarticular injection comparable to continuous epidural analgesia for postoperative pain after Total Knee Arthroplasty? A retrospective study. Willett, A., Lew, R., Wardhan, R.[2022]

The adductor canal block (ACB) is a promising alternative to the femoral nerve block for managing pain after knee surgeries, particularly knee arthroplasty.

This review discusses the anatomy and ultrasound-guided techniques for ACB, highlighting its potential benefits in pain control and patient recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adductor canal block for knee surgical procedures: review article. Vora, MU., Nicholas, TA., Kassel, CA., et al.[2017]

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]

In a study of 30 patients undergoing total knee arthroplasty, both adductor canal block (ACB) and femoral nerve block (FNB) provided similar levels of pain relief, with no significant difference in morphine consumption in the first 24 hours post-surgery.

Both techniques also preserved quadriceps strength equally well, showing no significant differences in muscle strength or functional recovery at 24 and 48 hours after the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomised controlled trial comparing adductor canal block and femoral nerve block for knee arthroplasty. Lim, YC., Quek, HYK., Phoo, WHJ., et al.[2020]

In a study of 70 patients undergoing arthroscopic knee surgeries under spinal anesthesia, those who received an adductor canal block (ACB) experienced significantly lower morphine consumption (8.63 mg) compared to those who did not receive the block (21.91 mg), indicating ACB's effectiveness in pain management.

The ACB not only prolonged the duration of analgesia (approximately 366 minutes vs. 150 minutes) but also resulted in lower pain scores during rest and knee flexion, while maintaining better hemodynamic stability and showing no complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial. Arumugam, P., Ravi, S., Ln, S., et al.[2023]

The single-injection adductor canal block (SACB) provides similar pain relief and opioid consumption compared to the continuous-injection adductor canal block (CACB) in the first 24 hours after total knee arthroplasty, based on a meta-analysis of four randomized controlled trials.

Both SACB and CACB techniques do not increase the risk of complications or length of hospital stay, suggesting that SACB is a safe and effective option for postoperative analgesia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty: A PRISMA-compliant meta-analysis. Zhang, LK., Zhang, BY., Quan, RF., et al.[2022]

References

1. 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]

2. Romania pubmed.ncbi.nlm.nih.gov

Is continuous proximal adductor canal analgesia with a periarticular injection comparable to continuous epidural analgesia for postoperative pain after Total Knee Arthroplasty? A retrospective study. [2022]

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

Adductor canal block for knee surgical procedures: review article. [2017]

4. 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]

5. India pubmed.ncbi.nlm.nih.gov

A randomised controlled trial comparing adductor canal block and femoral nerve block for knee arthroplasty. [2020]

6. China (Republic : 1949- ) pubmed.ncbi.nlm.nih.gov

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial. [2023]

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

Single shot versus continuous technique adductor canal block for analgesia following total knee arthroplasty: A PRISMA-compliant meta-analysis. [2022]