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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if surgeons can safely and effectively provide pain relief during knee replacement surgery using adductor canal blocks (ACB). The research will compare blocks performed by anesthesiologists before surgery to those done by surgeons during surgery. It may suit individuals with osteoarthritis scheduled for same-day discharge knee replacement. As an unphased trial, this study offers patients the chance to contribute to innovative surgical techniques that could improve recovery experiences.

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 prior data suggests that this technique is safe for knee arthritis surgery?

Research has shown that adductor canal blocks, a type of pain relief administered by anesthesiologists, are generally safe and effective for reducing pain after knee surgery. However, a small risk of complications exists, such as saphenous nerve neuralgia, which occurs in about 7.2% of cases, causing pain in the nerve near the knee.

For adductor canal blocks performed by surgeons, studies suggest they can be safely administered during surgery. Research indicates these blocks provide effective pain relief and aid recovery without extending surgery time or causing complications. No major side effects have been reported in studies where these blocks were used without ultrasound guidance.

Both methods are generally well-tolerated with few serious side effects, suggesting they might be a safe option for managing knee surgery pain. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about adductor canal blocks for knee arthritis because they offer a new approach to pain management during knee surgeries. Unlike standard care options like oral pain medications or epidural anesthesia, these blocks specifically target nerves in the thigh to block pain more precisely. The trial compares two methods: the anesthesiologist-performed adductor canal block (aACB), which is done before surgery, and the surgeon-performed adductor canal block (sACB), administered during surgery. This could lead to better pain control with fewer side effects, making recovery smoother for patients.

What evidence suggests that this trial's treatments could be effective for knee arthritis?

This trial will compare two methods of administering adductor canal blocks for knee arthritis. Studies have shown that adductor canal blocks performed by anesthesiologists (aACB) effectively control pain after knee replacement surgery, aiding patients in moving more easily soon after. However, these blocks can be time-consuming and costly due to the need for an anesthesiologist's expertise. Research also shows that adductor canal blocks performed by surgeons (sACB) can relieve pain just as effectively, without additional time or increased risk of complications during surgery. Both methods aim to help patients recover more comfortably and quickly after total knee surgery. ^{2 4 6 7 8}

Who Is on the Research Team?

Simon Garceau, MD

Principal Investigator

The Ottawa Hospital

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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 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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5919220/

Saphenous Nerve Block From Within the Knee Is Feasible for ... However, femoral nerve blocks risk causing quadriceps weakness and falls, and anesthesiologist-performed adductor canal blocks are costly in time and resources ...

2. arthroplastyjournal.org arthroplastyjournal.org/article/S0883-5403(24)00306-1/fulltext

Intraoperative Surgeon-Administered Adductor Canal ... This study examined the transition from traditional preoperative anesthesiologist-performed ultrasound-guided adductor canal blocks (“high-ACB”) ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0883540321008986

Ultrasound-Guided Adductor Canal Block Versus ... The ultrasound-guided adductor canal block (High-ACB) is an effective option for pain control in total knee arthroplasty (TKA), but its use can add substantial ...

4. bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-025-09087-9

Efficacy of direct adductor canal block in pain control and ... The adductor canal block has been proven effective in controlling postoperative pain, but it requires additional space and manpower.

5. journalmsr.com journalmsr.com/saphenous-nerve-neuralgia-a-potentially-devastating-complication-of-perioperative-adductor-canal-block-used-for-total-knee-arthroplasty-analgesia/

Saphenous nerve neuralgia: A potentially devastating ... Saphenous neuralgia occurred in 7.2% of patients following adductor canal block, with some cases severe enough to require further treatment.

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38599532/

Intraoperative Surgeon-Administered Adductor Canal ... This study examined the transition from traditional preoperative anesthesiologist-performed ultrasound-guided adductor canal blocks ("high-ACB") to low-ACB, ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0883540324003061

Intraoperative Surgeon-Administered Adductor Canal ... This study examined the transition from traditional preoperative anesthesiologist-performed ultrasound-guided adductor canal blocks (“high-ACB”) to low-ACB, ...

8. bjaopen.org bjaopen.org/article/S2772-6096(25)00005-X/fulltext

Adductor canal block in total knee arthroplasty: a scoping ... Adductor canal block is a safe and potentially effective peripheral nerve block for reducing postoperative pain after total knee arthroplasty while preserving ...