The adductor canal block (ACB) is the standard of care for analgesia after Anterior Cruciate Ligament (ACL) repair. ACB is performed by injecting local anesthetic (freezing) in the subsartorial canal in the thigh which is about 7-10cm long. Preliminary evidence suggests that different injection sites within the canal may produce different degrees of analgesia and quadriceps motor block. This trial seeks to determine the effects of various ACB injection sites on postoperative analgesia and motor power following ACL repair.
Adductor canal block (ACB) is replacing femoral nerve block (FNB) as the peripheral nerve block of choice for knee surgery. The ACB aims to inject local anesthetics (LA) within the neurovascular sheath in the subsartorial adductor canal around the femoral nerve. The point where the sartorius muscle crosses over the femoral artery is generally the accepted site for performing ACB. Clinically, injecting LA in the adductor canal blocks the sensory innervation of the knee and thus offers pain relief that is similar to FNB while conserving motor power around the knee. While these benefits are desirable, the exact location for performing ACB that ensures these benefits, remains debatable. The subsartorial adductor canal itself is 7-10cm long and the anatomical location of the sensory and motor nerves that innervate the knee and its surrounding muscles in this canal may vary. This randomized controlled trial is designed to identify and refine the ACB technique by clinically determining the effects of various ACB injection locations on postoperative analgesia and quadriceps motor power following ACL repair.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
108
Local anesthetic
Local anesthetic
Women's College Hospital
Toronto, Ontario, Canada
Cumulative 24 Hour Oral Morphine Equivalent Consumption
Post-Operative Analgesia
Time frame: 24 hours
Motor Power - Peak Force as measured by a dynamometer
Percentage decrease in quadriceps motor strength at 30 minutes following adductor canal block compare to baseline
Time frame: 30 Minutes post Block
Opioid Consumption
Intra-operative opioid consumption
Time frame: During surgical procedure
Total opioids in Post Anesthetics (PAC)
Cumulative oral morphine equivalent consumption in PACU
Time frame: Total length of time in PACU (total time in minutes from arrival in PACU to discharge to the Surgical Day Care is between 60-180 minutes
Pain Scores - Questionnaire
Area under the curve for rest pain scores plotted against time during the first 24 hours
Time frame: 24 hours post block
Quality of Recovery (QoR-15)
Quality of recovery measured using the QoR-15 at 24 hours postoperatively
Time frame: 24 hours postoperatively
Patient Satisfaction - Questionnaire
Patient satisfaction with analgesia - NRS Pain Scale 0(no pain to 10(worst pain)
Time frame: 24 hours postoperatively
Hospital Discharge (Time to hospital discharge)
Time to hospital discharge
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Time frame: Same day as surgical procedure
Nerve Block Complications
Presence/absence of nerve block complications during the first 24 hours postoperatively and 2 weeks after surgery
Time frame: 24 hours postoperatively and 2 weeks postoperatively