The objective of this trial is to compare the efficacy of three different nerve blocks as an analgesic option after total knee arthroplasty (TKA), based on muscle strength, mobilization and pain. The Adductor Canal Block has been proposed as an equally effective technique to the Femoral Nerve Block in terms of pain control after a TKA, with the benefit of preserving muscle function. We hypothesize that a block performed at the apex of the femoral triangle would best balance analgesia with quadriceps function.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
78
Nerve block that aims the vastus medialis nerve, the saphenous nerve and the anterior femoral cutaneous nerve.
Regional anesthetic technique that blocks the sensory and motor information of the femoral nerve (and it's branches).
Interfascial block that targets mainly the saphenous nerve.
Hospital Universitari Vall d'Hebron
Barcelona, Spain
Maximum voluntary isometric contraction (MVIC)
It measures quadriceps strength and is normalized to the body mass index (N \* m/kg). This test correlates well with the functional outcome. Will be measured with standard handheld dynamometer (MicroFET2; Hoogan Industries, West Jordan, Utah) perpendicular to the tibial crest 5 cm proximal to the medial malleolus to make the measurement. The patients are told to "reach maximum force and hold for three seconds." Three measurements will be done, and the average will be taken. The primary effectiveness endpoints of the study will be the percentage of baselineMVIC retained on the quadriceps of the leg receiving arthroplasty for each subject at 6 hours postoperatively. A higher the percentage will relate with less motor block.
Time frame: 6 hours postoperatively
Timed Up and Go (TUG)
Timed Up and Go gauges a patient's sense of balance by measuring the time required for a certain set of movements: stand up from a chair, walk 3 m, walk back, and sit down. It has been verified to serve as a good indicator of functional level. Measured in seconds, the better values are related to shorter times.
Time frame: 6, 24 and 48 hours postoperatively.
30' CST (30 secs Chair Stand Test)
How many times can a patient stand up and sit down from a chair in 30 seconds. The amount of times will be counted, more times will be related to a better outcome.
Time frame: 6, 24 and 48 hours postoperatively.
Range of Motion (ROM)
Range of motion refers to a knee's degree of extension or flexion and is measured via a goniometer. Considering normal values from 0-120º, the baseline movement will be measured preoperatively to be compared postoperatively.
Time frame: 6, 24 and 48 hours postoperatively.
Daniels' Test
Active extension of the knee against gravity and applied resistance (0-5). 5: normal contraction against gravity and maximal resistance. 0: abscence of contraction.
Time frame: 6, 24 and 48 hours postoperatively.
10-PMS (10 point Mobility Scale)
Scale from 0-10 in which the mobility of the patient is measured; sitting on the bed, chair, edge of the bed, mobilize the knee more than 45º, stand up, walk with or without a mobility aid. Higher values are related to better outcomes. An expected degree of flexion of the knee is ≥45 degrees on postoperative day 1 and ≥70 degrees on postoperative day 3. Expected points for postoperative day 0: 4 points Expected points for postoperative day 1: 8 points Expected points for postoperative day 2: 9-10 points
Time frame: 6, 24 and 48 hours postoperatively.
Pain measurement trough the visual analogue scale (VAS)
Pain will be measured via the VAS pain score by having the patient point on an unmarked scale how their pain was and then translating it to millimeters on the 100-mm scale. 0 mm: no pain 100 mm: severe/extreme pain
Time frame: 6, 24 and 48 hours postoperatively.
Quantity of opioids administered
into morphine equivalent if needed.
Time frame: 6, 24 and 48 hours postoperatively.
APS-POQ-R.
Developed by an interdisciplinary task force of members of the American Pain Society, the Patient Outcome Questionnaire (APS-POQ) for QI has been revised to include instrument psychometrics. The article is available by open access at The Journal of Pain web site.
Time frame: At 24 hours postoperatively
Patient satisfaction
Scale from 0 to 10, answering how do they feel about the treatment received, being 10 the maximum value related to the highest satisfaction level.
Time frame: 24 and 48 hours postoperatively
Length of hospital stay
Days from surgery until discharge.
Time frame: at patient discharge, an average of 6 days postoperatively
Maximum voluntary isometric contraction (MVIC)
It measures quadriceps strength and is normalized to the body mass index (N \* m/kg). This test correlates well with the functional outcome. Will be measured with standard handheld dynamometer (MicroFET2; Hoogan Industries, West Jordan, Utah) perpendicular to the tibial crest 5 cm proximal to the medial malleolus to make the measurement. The patients are told to "reach maximum force and hold for three seconds." Three measurements will be done, and the average will be taken. The primary effectiveness endpoints of the study will be the percentage of baselineMVIC retained on the quadriceps of the leg receiving arthroplasty for each subject at 6, 24, and 48 hours postoperatively. A higher the percentage will relate with less motor block.
Time frame: 24 and 48 hours postoperatively.
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