Pain Management Techniques for Total Knee Replacement
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial explores ways to manage pain after knee replacement surgery. It compares two approaches—a real numbing treatment (adductor canal catheter) and a placebo (sham catheter)—to determine which reduces opioid use in the days following surgery. Participants must communicate with their doctor using a mobile app during this period. The trial suits those scheduled for knee replacement due to osteoarthritis and who can follow the study's protocol. As an unphased trial, it offers participants the opportunity to contribute to innovative pain management solutions.
Will I have to stop taking my current medications?
The trial does not specify if you need to stop taking your current medications, but if you are using gabapentin, pregabalin, or opioids regularly, you may not be eligible to participate.
What prior data suggests that these pain management techniques are safe for total knee replacement patients?
Research has shown that an adductor canal catheter (ACC) is generally safe for managing pain after total knee replacement surgery. One study found that this method effectively reduces pain without causing serious side effects. Another study demonstrated that using a continuous catheter poses no greater risk than a single injection. Important safety concerns include falls, infections, nerve injuries, and muscle weakness, but these issues are rare and usually manageable. Overall, the ACC is well-tolerated and provides effective pain relief.12345
Why are researchers excited about this trial?
Researchers are excited about these pain management techniques for total knee replacement because they potentially offer a more targeted approach to pain relief. Unlike traditional methods that often rely on systemic painkillers like opioids, the adductor canal catheter delivers numbing medication directly to the operative leg, which may reduce the need for oral pain medication and its associated side effects. Additionally, the use of the Diagnotes application enables real-time communication with pain doctors, allowing for personalized pain management adjustments and potentially improving patient outcomes. This combination of local anesthesia and digital health monitoring represents a promising innovation in post-surgical care.
What evidence suggests that these pain management techniques could be effective for total knee replacement?
This trial will compare the effectiveness of an Adductor Canal Catheter (ACC) with a Sham Adductor Canal Catheter for pain management after knee replacement surgery. Research has shown that using an ACC can reduce pain following knee replacement surgery. Studies have found that continuous pain relief with an ACC provides better pain control than some other methods. However, some research suggests the additional benefit might be small. Adductor canal blocks, whether using a catheter or not, effectively manage pain after knee surgeries. Overall, ACCs appear to be a promising option for reducing pain and may help lower the need for opioids after surgery.56789
Who Is on the Research Team?
Stavros Memtsoudis, MD/PhD
Principal Investigator
Hospital for Special Surgery, New York
Jashvant Poeran, MD/PhD
Principal Investigator
Hospital for Special Surgery, New York
Are You a Good Fit for This Trial?
This trial is for adults aged 18-75 with osteoarthritis scheduled for knee replacement surgery at certain surgeons, living within an hour of the hospital, owning a smartphone, and able to follow instructions in English. Excluded are those with general anesthesia, drug allergies, BMI >40, diabetes, severe joint deformity or contracture, chronic opioid or gabapentin use.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Surgery and Immediate Post-operative Care
Participants undergo total knee arthroplasty and receive either an adductor canal catheter or a sham catheter for 50 hours post-surgery.
Transitional Pain Service (TeleTPS)
Participants use the Diagnotes app to communicate with the pain doctor while the catheter is in place, and manage pain post-discharge.
Follow-up
Participants are monitored for opioid consumption, chronic pain, and other outcomes up to 6 months post-operation.
What Are the Treatments Tested in This Trial?
Interventions
- Adductor Canal Catheter
- Sham Adductor Canal Catheter
Trial Overview
The study tests if there's a difference in opioid use after surgery between patients getting an adductor canal catheter (ACC) versus a sham catheter. It uses the Diagnotes app for communication and checks pain levels up to 6 months post-surgery.
How Is the Trial Designed?
2
Treatment groups
Experimental Treatment
Placebo Group
Patients will received the an adductor canal catheter that continuously infuses numbing medication to their operative leg for 50 hours post-surgery. Patients will also communicate with their pain doctor via the Diagnotes application while the catheter is in place.
Patients will received the a sham adductor canal catheter that is attached to their operative leg for 50 hours post-surgery. Patients will also communicate with their pain doctor via the Diagnotes application while the catheter is in place.
Find a Clinic Near You
Who Is Running the Clinical Trial?
Hospital for Special Surgery, New York
Lead Sponsor
Published Research Related to This Trial
Citations
The effects of continuous catheter adductor canal block for ...
Our meta-analysis appears to demonstrate that continuous administration of analgesia through an adductor canal catheter provides greater pain reduction in ...
Is There Benefit in Using an Adductor Canal Catheter in ...
We found that not using the ACC was noninferior to using the ACC, suggesting that the incremental benefit of the ACC is small and likely of insufficient ...
Epidural Catheter With or Without Adductor Canal Nerve ...
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 ...
Outpatient continuous adductor canal block (CACB) for ...
Single-injection adductor canal blocks (SACB) provide effective but short-lived pain relief after total knee arthroplasty, with limited ...
Adductor Canal Block for Knee Surgeries: An Emerging ...
ACB is an emerging technique for postoperative analgesia following knee surgery and is as effective as FNB in postoperative pain control.
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 ...
a systemic review and meta-analysis of randomized trials
Conclusions Our results suggest that continuous catheter-based ACB does not enhance or prolong the analgesic benefits when compared with single-shot ACB for TKA ...
Adductor canal block in total knee arthroplasty: a scoping ...
Important safety outcomes were falls, infection, nerve injury, and quadriceps weakness. Methods. We used the Preferred Reporting Items for Systematic Reviews ...
Adductor Canal Nerve Block Following Total Knee ...
The purpose of this study is that an adductor canal nerve block (putting numbing medicine near the nerve) has been shown to produce excellent pain relief with ...
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