Ambulatory Continuous Adductor Canal Block to Facilitate Same Day Discharge Following Total Knee Arthroplasty: A Pilot Study

Sponsor

Lawson Health Research Institute (Other)

Overall Status

Completed

CT.gov ID

NCT02228759

Collaborator

(none)

Enrollment

Location

Arm

Duration (Months)

3.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Patients scheduled to undergo total knee arthroplasty will receive motor sparing knee blocks with continuous adductor canal block along with multimodal analgesia started pre-operatively and continued into the postoperative period. The study will evaluate the feasibility of home discharge within the first 24 hours following total knee arthroplasty. We will also evaluate the pain scores in the first 5 days following the surgery, causes of delayed discharge and any adverse events.

Condition or Disease	Intervention/Treatment	Phase
Knee Osteoarthritis	Procedure: Adductor canal block	N/A

Study Design

Study Type:

Interventional

Actual Enrollment :

25 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Supportive Care

Study Start Date :

Apr 1, 2015

Actual Primary Completion Date :

Dec 1, 2015

Actual Study Completion Date :

Dec 1, 2015

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Adductor canal block The study is an open label pilot study to determine the feasibility of same day discharge following total knee arthroplasty with the use of a fast track regimen employing motor sparing knee blocks. The study will be performed on 25 American Society of Anesthesiologists class (ASA) 1-2 patients satisfying the inclusion criteria and undergoing unilateral primary total knee arthroplasty. First and second patients of the day undergoing surgery between Monday to Thursday in a week will be accessed for the study.	Procedure: Adductor canal block All patients will recieve fast tracking with reduced fasting times, multimodal analgesia and adductor canal block

Arm

Intervention/Treatment

Experimental: Adductor canal block

The study is an open label pilot study to determine the feasibility of same day discharge following total knee arthroplasty with the use of a fast track regimen employing motor sparing knee blocks. The study will be performed on 25 American Society of Anesthesiologists class (ASA) 1-2 patients satisfying the inclusion criteria and undergoing unilateral primary total knee arthroplasty. First and second patients of the day undergoing surgery between Monday to Thursday in a week will be accessed for the study.

Procedure: Adductor canal block

All patients will recieve fast tracking with reduced fasting times, multimodal analgesia and adductor canal block

Outcome Measures

Primary Outcome Measures

percentage of patients discharged at 23 hours based on a composite of various factors represented on a pre-determined criteria [24 hours]

Secondary Outcome Measures

first 24 hour pain scores [24 hours]
first 96 hour pain scores [96 hours]
Rescue analgesic frequency [24 hours]
total analgesic usage in the first 24 and 96 postoperative hours [96 hours]

Eligibility Criteria

Criteria

Ages Eligible for Study:

40 Years to 70 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male and females of 40-70years of age
Scheduled to undergo unilateral primary total knee arthroplasty
ASA Class I, II

Exclusion Criteria:

ASA 3, 4
Revision surgery
Narcotic dependent (opioid intake morphine equivalent > 10 mg/ day for more than 3 months)
Other sources of chronic pain like fibromyalgia
Patients with associated significant cardiac, CNS or respiratory disease (poor cardio-respiratory reserve)
Major conduction defects in EKG (bifascilular block, CHB); significant valvular heart disease
Recent MI/ Stroke/ CHF (in the past 3 months)
BMI> 35
Obstructive sleep apnea (AHI > 15)
Patients with coexisting hematological disorder or with deranged coagulation parameters.
Patients with pre-existing major organ dysfunction such as hepatic and renal failure.
Psychiatric illnesses
Uncontrolled diabetes mellitus
Lack of informed consent.
Allergy to any of the drugs used in the study
Preoperative neurological deficits
Use of walking aids preoperatively
Living alone (Lack of Chaperone/home help)
Language barrier
Contralateral leg weakness
Pregnancy