Comparison of Two Multimodal Analgesia Regimens in Total Knee Arthroplasty

• Status: Terminated
• Trial end date: 2019-10-01
• Target enrollment: 0
• Participant gender: All

Summary

The improvement of postoperative analgesia is an important issue in orthopedic surgery, especially after total knee arthroplasty The use of a peripheral nerve block such as the adductor canal block is favored since it offers a postoperative analgesia superior to opioids, and also preserves the strength of the quadriceps, as opposed to the femoral block.

The adductor canal block can be given as a single injection (single shot) or a continuous perineural infusion to extend the block's analgesic duration. It is unclear if the continuous infusion is superior to the single shot. Indeed, a high catheter dislodgement rate is observed for this location and local anesthetics could migrate into the femoral canal, resulting in quadriceps weakness. Alternatively, adequate postoperative analgesia has been shown effective with a single shot adductor canal block combined with extended release opioids.

The primary objective in this study is to compare two analgesic protocols on the pain score at walk 24 hours after total knee arthroplasty.

Here are the two protocols compared :

1. Adductor canal block followed by continuous perineural perfusion for 48 hours

2. Adductor canal block (single shot) followed by hydromorphone extended release formulation for 48 hours In addition to analgesic adjuvants administered in both groups : acetaminophen, celecoxib, pregabalin, dexamethasone and periarticular infiltration.

Our hypothesis is that both protocols ensure a similar analgesia.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Ciusss de L'Est de l'Île de Montréal
• Treatments: Hydromorphone; Ropivacaine

Criteria

Inclusion Criteria:

• Patients aged 18-80 years old

• American Society of Anesthesiology physical status I-III

• Primary total knee arthroplasty surgery under regional anesthesia

Exclusion Criteria:

• Chronic kidney disease (CKD) with eGFR < 60mL/min

• Contraindications for the use of spinal anesthesia or adductor canal block :

infection, sepsis, evolutive neurological disease, coagulopathy, patient refusal.

• Chronic use of opioids (>30 mg daily morphine equivalent)

• Documented allergy to Hydromorphone, tramadol, celecoxib, ropivacaine, pregabalin, acetaminophen and/or ketorolac

• Patient weight < 50 kg or BMI > 40

• Severe cardiac disease

• Severe pulmonary disease

• Chronic use of monoamine oxydase inhibitors

• Pregnancy

• Inability to give informed consent

• Patient refusal