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Adductor Canal Block In Anterior Cruciate Ligament (ACL) Repair

This study has been completed.
Information provided by (Responsible Party):
University Health Network, Toronto Identifier:
First received: February 11, 2013
Last updated: March 2, 2015
Last verified: March 2015
Adductor canal block will provide adequate analgesia to patients undergoing arthroscopic ACL reconstruction surgery, yet result in less motor blockade than a femoral block.

Condition Intervention
Neuromuscular Block
Procedure: Adductor Canal Block
Procedure: Femoral Nerve Block

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Postoperative Analgesia Produced by Adductor Canal (Distal Femoral Artery Compartment) Block Is Not Inferior to Femoral Nerve Block In Outpatient Arthroscopic Anterior Cruciate Ligament Repair

Further study details as provided by University Health Network, Toronto:

Primary Outcome Measures:
  • Opioid consumption [ Time Frame: 24 hours ]
    Postoperative cumulative opioid consumption during the first 24 hours. All doses of supplemental (PRN) oral and parenteral opioid analgesics required will be converted into equivalent doses of oral morphine

  • Motor Blockade [ Time Frame: 30 minutes ]
    The degree of motor blockade 30 minutes following the block procedure

  • Pain Scores [ Time Frame: 12,24 and 48 hours ]
    Visual Analog Pain scores at rest and with movement at admisssion and discharge from post-anesthesia care unit (PACU), AT DISCHARGE FROM same day surgery unit (SDC) and at 12, 24 and 48 hours

Secondary Outcome Measures:
  • Sensory blockade [ Time Frame: 30 min ]
    The degree of sensory blockade 30 minutes following the block procedure

  • Spread of local anesthetic [ Time Frame: 30 min ]
    Spread of local anesthetic from the injection site

Other Outcome Measures:
  • Block procedure time [ Time Frame: min ]
    Block procedure time from probe placement on the skin to time of needle exit

  • Block success [ Time Frame: 30 min ]
    1 or 0 on both sensory and motor block testing after 30 min for success

Enrollment: 100
Study Start Date: May 2013
Study Completion Date: March 2015
Primary Completion Date: March 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Adductor Canal Block Group
Adductor Canal Block
Procedure: Adductor Canal Block
Examination of the adductor canal using ultrasound will be performed using a high frequency linear probe. Following this the ultrasound probe will be positioned perpendicular to the skin in the medial upper-thigh region. The ultrasound probe will be moved either cephalad or caudad from its initial position in order to visualize the femoral artery immediately deep to the middle of the sartorius muscle. This point will then be selected as the appropriate level for needle insertion. Sham blocks using subcutaneous injection of normal saline will be used in both groups to maintain patient blinding.
Active Comparator: Femoral Nerve Block Group
Femoral Nerve Block
Procedure: Femoral Nerve Block
Examination of the femoral nerve using ultrasound will be performed using a high frequency linear probe. Following this the ultrasound probe will be positioned perpendicular to the skin at the level of the femoral crease. The femoral artery will be identified and the femoral nerve will then be located immediately lateral to the artery, deep to the fascia iliaca and superficial to the iliopsoas muscle. The needle will be positioned next to the femoral nerve. Following this 20 ml of 0.25% bupivacaine with epinephrine will be injected incrementally over a 1 to 2 minute period. Sham blocks using subcutaneous injection of normal saline will be used in both groups to maintain patient blinding.

Detailed Description:
This study is designed to demonstrate that postoperative analgesia produced by the adductor canal block is not inferior to that produced by femoral nerve block in patients undergoing arthroscopic ACL reconstruction surgery. The study will also compare the degree of motor blockade of the adductor canal block to that of the femoral nerve block.

Ages Eligible for Study:   18 Years to 50 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

American Society of Anesthesiologists(ASA)classification I-III, Patients 18 to 50 years of age, BMI 18 - 40. Patients scheduled for anterior cruciate ligament reconstruction surgery under general anesthesia and nerve blocks.

Exclusion Criteria:

Refusal or inability to provide informed consent. Any contraindication to regional anesthesia including coagulopathy or bleeding diathesis, allergy to local anesthetics, infection, nerve injury or malignancy at the site of the block.

History of alcohol/drug dependence. History of long term opioid intake or chronic pain disorder. History of preexisting neuropathy in the operative leg History of significant psychiatric conditions that may affect patient assessment.

Inability to understand the informed consent and demands of the study. Allergy to any of the components of the multimodal analgesic regimen.

  Contacts and Locations
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Please refer to this study by its identifier: NCT01791036

Canada, Ontario
Women's College Hospital
Toronto, Ontario, Canada, M5S 1B2
Sponsors and Collaborators
University Health Network, Toronto
Principal Investigator: Vincent Chan, MD University of Toronto
Principal Investigator: Richard Brull, MD UHN - Women's College Hospital and Toronto Western Hospital