Nerve Block for Total Knee Replacement

(CACB Trial)

Overseen By David Backstein, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Must not be taking: Chronic opioids

Disqualifiers: Alcohol, Drug dependency, Coagulopathy, others

Compensation: Varies

Number of Visits: 26

Duration: 48 hours

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines the effectiveness of a continuous adductor canal block, a pain-reduction method, for individuals undergoing knee replacement surgery. The researchers aim to determine if this method can reduce opioid use and enhance recovery. Participants will receive either a continuous nerve block or a placebo to compare outcomes. The trial is designed for those having a single knee replacement who can tolerate a small tube placed near their nerve for pain relief. The study seeks to identify better pain management options that could lead to quicker recovery and reduced reliance on strong pain medications. As an unphased trial, it offers a unique opportunity to advance pain management strategies for knee replacement patients.

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 opioids regularly, you may not be eligible to participate.

What prior data suggests that this continuous nerve block is safe for total knee arthroplasty?

Research shows that the continuous adductor canal block (CACB) is generally safe for people undergoing total knee replacement surgery. Studies have found that this method effectively reduces pain and decreases the need for opioids, which are strong painkillers with potential side effects. CACB appears to lower pain levels and aid in faster recovery after surgery.

Reports indicate that most patients tolerate CACB well, experiencing no serious side effects. However, like any medical treatment, some risks may exist. Current evidence suggests that CACB is a promising option for managing pain during knee surgery recovery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the continuous adductor canal block (CACB) for total knee replacement because it offers a potentially more targeted way to manage post-surgery pain. Unlike traditional pain management methods like oral painkillers or epidurals, CACB specifically blocks nerve signals in a key area of the leg, which may reduce pain without affecting muscle strength or mobility. This localized approach could help patients recover faster and get back on their feet sooner, which is a significant improvement over current standard treatments.

What evidence suggests that continuous adductor canal block is effective for pain management in total knee arthroplasty?

Research has shown that a continuous adductor canal block (CACB), which participants in this trial may receive, provides better pain relief for individuals undergoing total knee replacement surgery. Studies have found that CACB offers longer-lasting pain control compared to single-injection methods, which typically stop working within 24 hours. One study found that CACB improves both pain and movement recovery after surgery. Another study suggested that CACB not only reduces the need for additional pain medication but also enhances the overall recovery experience. Overall, CACB appears to be a promising option for managing pain after knee replacement surgery. ^{1 3 4 6 7}

Who Is on the Research Team?

Naveed Siddiqui, MD

Principal Investigator

Associate Professor

Are You a Good Fit for This Trial?

This trial is for adults over 21 years old who are having a knee replacement in a fast track program and have no drug or alcohol dependency. They must be generally healthy (ASA I-III), not dependent on opioids, without allergies to the study drugs, coagulopathy, low platelets, or issues that prevent catheter placement at the surgery site.

Inclusion Criteria

I understand and agree to the use of a nerve block catheter.

No alcohol or drug dependency

I am over 21 and fit for surgery according to ASA standards.

Exclusion Criteria

Allergy to the study medications

I have been taking the equivalent of 30mg morphine daily for the last 2 weeks.

Coagulopathy and platelet count less than 105/μL

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Preoperative Preparation

Patients undergo pre-anesthesia consultation and receive study information and consent forms

A few days before surgery

1 visit (in-person)

Treatment

Patients receive either continuous adductor canal block or sham block during and after surgery

48 hours

In-hospital stay and discharge

Postoperative Monitoring

Data collection on opioid consumption, pain intensity, and quality of recovery

90 days

Data collection at 24, 48, 72 hours, 7, 30, and 90 days postoperatively

Follow-up

Participants are monitored for safety and effectiveness after treatment

90 days

What Are the Treatments Tested in This Trial?

Interventions

• Continuous Adductor Canal Block

Trial Overview The study tests if continuous adductor canal block (CACB) with ropivacaine provides better pain control and recovery compared to a sham procedure (ShACB) using saline after knee replacement surgery. It measures opioid use, quality of recovery scores, pain levels, side effects from opioids, functional status post-surgery, complications related to the nerve block catheter and hospital readmissions.

How Is the Trial Designed?

Group I: CACB Active Control 1 Intervention

continuous adductor canal block

Group II: Control group Placebo Group 1 Intervention

sham continuous adductor canal block - ShACB

Who Is Running the Clinical Trial?

Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Lead Sponsor

Trials

132

Recruited

11,400+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6890367/

Effectiveness of continuous adductor canal block versus ... This study aimed to evaluate the effectiveness of continuous adductor canal block (CACB) versus continuous femoral nerve block (CFNB) in postoperative analgesia ...

2. rapm.bmj.com rapm.bmj.com/content/early/2025/09/10/rapm-2025-106991

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 ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5129513/

Analgesic Efficacy of Adductor Canal Block in Total Knee ... Our results suggest that, compared with saline, ACB decreases analgesic consumption and offers short‐term advantages in terms of pain relief.

4. clinicaltrials.gov clinicaltrials.gov/study/NCT05100706

Continuous Adductor Canal Block in Outpatient Total Knee ... Postoperative continuous adductor canal block for total knee arthroplasty improves pain and functional recovery: A randomized controlled clinical trial. J ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S1743919119302778

Continuous adductor canal block is a better choice ... Compared with SACB, CACB provides better analgesia after TKA. Therefore, CACB is recommended as an analgesic method for early postoperative pain treatment ...

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40177059/

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 ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S277260962500005X

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