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Adductor Canal Block With Posterior Capsular Injection for Total Knee Replacement

This study has been completed.
Information provided by (Responsible Party):
Saint Francis Care Identifier:
First received: March 4, 2013
Last updated: March 16, 2015
Last verified: January 2015
To compare early ambulation and ability to participate in rehabilitation in patients undergoing total knee replacement using two different nerve block techniques for pain control. The 2 methods are 1) Adductor canal block with posterior capsular injection 2) femoral nerve block with tibial nerve block

Condition Intervention
Procedure: Canal Block and Capsular Injection
Procedure: Femoral with Tibial Nerve Block

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Care Provider)
Primary Purpose: Treatment
Official Title: Assessment of Early Ambulation and Participation in Rehabilitation Program in Patients Receiving Continuous Adductor Canal Block With Ultrasound Guided Posterior Capsular Knee Injection vs Continuous Femoral Nerve Block With Tibial Nerve Block Following Total Knee Replacement.

Resource links provided by NLM:

Further study details as provided by Saint Francis Care:

Primary Outcome Measures:
  • Ability to ambulate post operatively. [ Time Frame: Up to 3 days (72 hours) post surgery. ]
    Ability to ambulate and perform tasks of the rehabilitation program and reach rehabilitation milestones after total knee arthroplasty.

Secondary Outcome Measures:
  • Pain scores at rest and with knee flexion. [ Time Frame: Up to 3 days ( 72 hours) after surgery ]
    Measures of pain score using numeric pain rating scale (0=no pain, 10=worst pain) completed by patient in recovery room and every 6 hours for a 72 hour period after discharge from recovery room.

  • Pain Medication Consumption [ Time Frame: Up to 3 days (72 hours) post surgery ]
    Amount of opioid consumption post surgery for 72 hours.

Enrollment: 56
Study Start Date: March 2013
Study Completion Date: December 2013
Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Femoral With Tibial Nerve Block
Continuous femoral nerve block with catheter and selective tibial nerve block in the popliteal fossa
Procedure: Femoral with Tibial Nerve Block
Continuous femoral nerve block with 15 ml of ropivacaine 0.1% followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days after surgery combined with tibial nerve block in the popliteal fossa with ropivacaine 0.1% up to 15 ml.
Experimental: Canal Block and Capsular Injection
Adductor canal block with a continuous catheter and ultrasound guided posterior capsular injection with local anesthetic solution.
Procedure: Canal Block and Capsular Injection
Continuous Adductor canal block with 15-30ml of ropivacaine 0.1% with epinephrine 1:400,000 followed by an infusion of ropivacaine 0.1% at 6 ml per hour for 2 days post operatively. This is combined with ultrasound guided posterior capsular knee injection with 30 ml ropivacaine 0.1% with epinephrine 1:400,000.

Detailed Description:
Early mobilization in the postoperative period is important to the success of surgery following total knee replacement. However, severe post-operative pain is an impediment to early implementation of rehabilitaion program. The use of femoral nerve block combined with tibial nerve block as part of a multimodal analgesic program provides effective pain control but causes weakness of the operative extremity preventing patients from bearing weight, exercising the leg and increasing the risk of falls thereby delaying early participation in rehabilitation. Adductor canal block is a new technique that has been described to provide pain control after total knee arthroplasty (1). The advantages of this block is that it could potentially minimize lower extremity weakness because the target nerve (saphenous nerve) blocked in this technique is a purely sensory nerve and does not provide any motor innervation to any muscle groups. Adductor canal block lends itself easily to providing prolonged analgesia because a perineural catheter can be inserted and the block maintained by a continuous infusion of dilute local anesthetic solution for days. A disadvantage of this method is that it may not provide adequate analgesia for posterior knee pain in the early postoperative period. By combining adductor canal block with ultrasound guided posterior and antero-medial knee injection, the posterior knee pain can be controlled effectively. Posterior and antero-medial knee injection of local anesthetic solution has been used as a method of controlling posterior knee pain after total knee arthroplasty (2).

Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients having primary, unilateral total knee arthroplasty
  • ages 18 - 80

Exclusion Criteria:

  • history of neurological disease
  • neuropathy
  • diabetes
  • major systemic illness
  • pregnancy
  • chronic narcotic use
  • allergy to local anesthetic solution or NSAIDS
  • inability to give consent or cooperate with the study protocol
  • BMI> 40
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Please refer to this study by its identifier: NCT01805661

United States, Connecticut
Saint Francis Hospital and Medical Center
Hartford, Connecticut, United States, 06105
Sponsors and Collaborators
Saint Francis Care
Principal Investigator: Sanjay Sinha, M.D. Saint Francis Hospital and Medical Center
  More Information

Responsible Party: Saint Francis Care Identifier: NCT01805661     History of Changes
Other Study ID Numbers: 12-10-002
Study First Received: March 4, 2013
Last Updated: March 16, 2015

Keywords provided by Saint Francis Care:
early ambulation
knee arthroplasty

Additional relevant MeSH terms:
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases processed this record on May 23, 2017