Pain Management Techniques for ACL Surgery

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Davis

Disqualifiers: Prior knee surgery, Pregnancy, Arthritis, others

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

Compensation: Varies

Number of Visits: 5

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to evaluate the effectiveness of two pain management methods for individuals undergoing ACL (anterior cruciate ligament) surgery. One group will receive an adductor canal nerve block, while the other will not. Researchers seek to determine if both methods offer the same level of pain control during and after surgery. The trial is suitable for adults aged 18 to 45 who require ACL surgery. As an unphased trial, it provides participants the chance to contribute to valuable research that could enhance pain management strategies for future patients.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these pain management techniques are safe for ACL surgery?

Research has shown that the adductor canal nerve block is a common method for managing pain after ACL surgery. One study found it reduces pain after knee surgeries with fewer side effects compared to other nerve blocks, such as the femoral nerve block. This approach may result in less muscle weakness, which is beneficial for patients.

Another study measured pain levels at various times after surgery using a pain score. The results indicated that patients who received the adductor canal nerve block reported manageable pain levels within the first three days, suggesting the block is generally well-tolerated.

Overall, research suggests that the adductor canal nerve block is a safe option for managing pain after ACL surgery, with few reports of serious issues. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the adductor canal nerve block technique for ACL surgery pain management because it offers a targeted approach to numbing the nerves that supply sensation to the knee. Unlike standard methods like general anesthesia or other nerve blocks that affect larger areas, this technique focuses specifically on the adductor canal, potentially reducing side effects like muscle weakness. Additionally, it uses ropivacaine, which is known for its long-lasting effect, providing extended pain relief post-surgery. By minimizing pain more precisely, this method could enhance recovery and improve overall patient comfort.

What evidence suggests that these pain management techniques could be effective for ACL surgery?

Research has shown that the adductor canal nerve block (ACB), which participants in this trial may receive, effectively manages pain after ACL surgery. Studies comparing ACB to other methods have found it equally effective for pain control. One study found that ACB provides pain relief similar to the femoral nerve block. These findings suggest that ACB is a reliable choice for reducing pain after ACL reconstruction. ^{6 7 8 9 10}

Who Is on the Research Team?

Cassandra Lee, MD

Principal Investigator

UC-Davis Health

Are You a Good Fit for This Trial?

This trial is for adults aged 18-45 who have confirmed ACL tears and are recommended to undergo reconstructive surgery. It's not suitable for those unable to consent, pregnant women, individuals with inflammatory arthritis, non-English speakers, anyone with prior knee surgeries, or prisoners.

Inclusion Criteria

My ACL tear is confirmed by tests and I need surgery.

Exclusion Criteria

Prisoners

I have inflammatory arthritis.

Pregnant women

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-operative

Participants complete the Brief Resiliency Scale questionnaire and receive pre-operative pain medication prescriptions

1 day

1 visit (in-person)

Surgery and Immediate Post-op

Participants undergo ACL reconstruction surgery and complete a Visual Analog Scale for pain assessment in the recovery room

1 day

1 visit (in-person)

Post-operative Treatment

Participants follow a prescribed pain medication regimen and maintain a pain diary for 6 weeks

6 weeks

1 visit (in-person) at 6 weeks

Follow-up

Participants complete the Knee Injury and Osteoarthritis Outcome Score at 3 months and the Marx Activity Rating Scale at 6 months to assess knee function

6 months

2 visits (in-person) at 3 and 6 months

What Are the Treatments Tested in This Trial?

Interventions

• Adductor Canal Nerve Block
• Ropivacaine injection

Trial Overview

The study compares standard pain management techniques during ACL reconstruction surgery. Specifically, it looks at the effectiveness of an adductor canal nerve block using Ropivacaine injection versus no nerve block in controlling pain and improving functional outcomes post-surgery.

How Is the Trial Designed?

Group I: Adductor Canal Nerve Block Experimental Treatment 2 Interventions

Participant will receive an adductor canal nerve block via 15 mL 0.5% ropivacaine injection prior to OR for ACL reconstruction. Participant will receive pre-op oral medications.

Group II: No Nerve Block Active Control 1 Intervention

Participant will receive pre-op oral medications but no nerve block prior to OR for ACL reconstruction.

Who Is Running the Clinical Trial?

University of California, Davis

Lead Sponsor

Trials

958

Recruited

4,816,000+

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]

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]

Citations

1.

sciencedirect.com

sciencedirect.com/science/article/pii/S074980632500060X

Addition of Adductor Canal Block to Local Infiltration ...

This retrospective study analyzed ACL reconstructions performed from 2019 to 2021. Patients were included if they received either LIA alone ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC11565623/

Postoperative Pain Control After ACL Reconstruction With ...

Both adductor canal block (ACB) and local infiltration (LI) are effective for postoperative pain management after arthroscopic-assisted anterior cruciate ...

3.

ecios.org

ecios.org/DOIx.php?id=10.4055/cios23149

Meta-Analysis of Randomized Controlled Trials

Outcome comparison of femoral nerve block and adductor canal block during anterior cruciate ligament reconstruction: adductor canal block ...

4.

mdpi.com

mdpi.com/2077-0383/12/18/6019

The Effectiveness of Adductor Canal Block Compared to ...

This study evaluated the effect of adductor canal block (ACB) versus femoral nerve block (FNB) on readiness for discharge in patients undergoing outpatient ...

5.

journals.lww.com

journals.lww.com/md-journal/fulltext/2022/06240/comparison_of_adductor_canal_block_and_femoral.17.aspx

Comparison of adductor canal block and femoral nerve ...

Adductor canal block shows similar and adequate analgesia compared to the femoral nerve block in anterior cruciate ligament reconstruction.

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC11555719/

Local Infiltration Analgesia Versus Adductor Canal Block ...

Adductor canal block (ACB) and local infiltration analgesia (LIA) are frequently used to manage pain in patients after anterior cruciate ligament ...

7.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC7360326/

Femoral nerve block vs adductor canal block after anterior ...

Femoral nerve block (FNB) is considered the preferred analgesia after anterior cruciate ligament reconstruction (ACLR), but leads to weakness in the quadriceps ...

8.

sciencedirect.com

sciencedirect.com/science/article/pii/S2214687324000086

Periarticular cocktail injection is more useful than nerve ...

Following ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block ...

9.

clinicaltrials.gov

clinicaltrials.gov/study/NCT03053401

Ultrasound Guided Adductor Canal Versus Femoral Nerve ...

Both Ultrasound guided Adductor Canal Block ( ACB) and Femoral Nerve Block (FNB) has been used to provide postoperative analgesia for knee surgeries.

10.

isakos.com

isakos.com/GlobalLink/Abstract/7236

Adductor Canal Block and Periarticular Cocktail Injection ...

Following ACL reconstruction, patients' numerical rating scale pain scores (0–10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h after surgery. Results.