Single Dose Adductor Canal Block vs SPANK Block for TKA

San Antonio Uniformed Services Health Education Consortium128 enrolled

Overview

This is a prospective, randomized control trial to compare SPANK block combined with adductor canal block to adductor canal block alone in treatment of post-operative pain after total knee arthroplasty. The primary outcome is pain control, which will be measured throughout the post-operative course using morphine equivalents of opioid analgesics used during the first 24 hours after surgery. Secondary outcomes include pain scores recorded at 4, 8, 12, 16, 20, and 24 hours post-operatively, cumulative pain score, incidence of post-operative nausea and vomiting, and extent of motor blockade. The study will aid in answering the question of whether SPANK block is an effective adjunct in preventing pain and decreasing opioid requirement after TKA.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

128

Conditions

Osteo Arthritis Knee Pain, Postoperative Pain, Acute

Interventions

SPANK Block (Sensory Posterior Articular Nerves of the Knee)PROCEDURE

Injection of local anesthetic into the tissues on the posterior aspect of the knee to provide sensory blockade of the articular nerves of the knee.

Adductor Canal BlockPROCEDURE

Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the knee

Ropivacaine Hcl 0.5% Inj Vil 30MlDRUG

Amide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. The drug itself is not being studied and the same concentration will be used in all participants.

Pajunk sonoplex stim needleDEVICE

Echogenic needle used for ultrasound guided nerve blockade.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients between the ages of 40 and 80 years old undergoing total knee arthroplasty amenable to peripheral nerve block for perioperative analgesia. * BMI \<45 * ASA class III or less Exclusion Criteria: * Inability to sign consent form * Allergy to medications used in the study * Repeat surgery * History of seizure disorder * Simultaneous bilateral TKA * History of substance abuse * BMI \>45 * Opioid consumption of greater or equal to 30mg morphine equivalents per day * Age \<40 or \>80 years old * ASA IV or greater * Inability to use a PCA * Inability to access the intrathecal space * Infection at the site of injection (either for spinal or PNB) * INR greater than or equal to 1.4

Outcomes

Primary Outcomes

Postoperative Opioid Consumption

Amount of opioids used within the first 24 hours post-operatively, starting from when the patient leaves the operating room, measured in PO morphine equivalents

Time frame: 24 hours postoperatively

Secondary Outcomes

Postoperative Pain Scores

Verbal pain score measured via numerical rating scale from 1-10 at 4 hrs, 8 hrs, 12hrs, 16hrs, and 24 hours.

Time frame: 4, 8, 12, 16, and 24 hours postoperatively

Time to first opioid use

The amount of time measured from when the patient leaves the operating room to the time when they receive their first dose of any opioid medication.