This study seeks to examine the analgesic efficacy of genicular nerve blocks for pain after total knee replacement.
Part of the way in which pain is controlled during total knee replacement surgery is through a nerve block. The investigators have developed an effective protocol for pain control after knee replacement, but know that many patients still experience pain around the knee after knee replacement. There are nerves around the knee that carry pain impulses from behind the knee. The investigators believe that placing numbing medicine around these nerves can help with pain in front of the knee after surgery, in addition to the standard nerve block placed for knee replacement surgery. This may result in taking less pain medication by mouth,and having less pain with movement. For this study, before the operation, either a placebo solution or the local anesthetic bupivacaine (a numbing solution) will be placed at three sites around the knee where these nerves reside. The investigators will evaluate how participants feel in recovery after surgery, during the stay in the hospital, and call at home one week after surgery. Knowing if numbing these nerves helps with pain after surgery will help us further refine our postoperative care plan for patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
40
Patients will be randomly assigned to either a genicular nerve block with bupivacaine or saline
The ultrasound-guided genicular nerve block will be performed at the site of the superior lateral, the superior medial, and the inferior medial genicular nerves. Color Doppler will be used to identify the arterial structures which serve as landmarks for the corresponding nerves. After skin local anesthetic infiltration, a 10 cm 21G insulated block needle will be inserted and aligned with the ultrasound scanning plane. Once satisfactory position of the needle is confirmed, 5mL of a solution containing 15 ml of 0.25% bupivacaine with 2mg dexamethasone or 5mL saline will be slowly injected. Spread of local anesthetic will be documented adjacent to the target nerve. This procedure will be performed at the site of the three genicular nerves described.
Duke University Hospital
Durham, North Carolina, United States
Opioid Consumption at 24 Hours Post-op
Opioid consumption documented in medical recorded will be converted to oral morphine equivalents.
Time frame: 24 hours after operation
Worst Pain Rating Score (NRS-11) at Rest on Postoperative Day 1
The Numerical Rating Scale (NRS) is an 11-point numeric rating scale, with 0 representing "no pain" and 10 "unbearable pain." This scale demonstrates reliability and validity and is widely used to assess acute pain after surgery.
Time frame: Postoperative Day 1
Worst Pain Rating Score (NRS-11) With Movement on Postoperative Day 1
The Numerical Rating Scale (NRS) is an 11-point numeric rating scale, with 0 representing "no pain" and 10 "unbearable pain." This scale demonstrates reliability and validity and is widely used to assess acute pain after surgery.
Time frame: Postoperative day 1
Total Opioid Consumption Through 48 Hours
Total of all opioids consumed converted to oral morphine equivalents.
Time frame: 48 hours
Opioid Consumption on Postoperative Day 7
Self-reported (by telephone questionnaire) opioid consumption in oral morphine equivalents on postoperative day 7
Time frame: Postoperative day 7
Worst Pain Rating Score (NRS-11) on Postoperative Day 7
The Numerical Rating Scale (NRS) is an 11-point numeric rating scale, with 0 representing "no pain" and 10 "unbearable pain." This scale demonstrates reliability and validity and is widely used to assess acute pain after surgery.
Time frame: Postoperative day 7
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Patients will be randomly assigned to either a genicular nerve block with bupivacaine or saline
Sleep Quality Measured by Number of Times Awakened by Pain During the First Postoperative Night
The patient will be questioned by a member of the research team about how many times they were awoken by pain overnight.
Time frame: Postoperative day 1
Patient Satisfaction With Pain Control at 24 h
Patient reported satisfaction with his/her pain control at 24 h on a scale of 0-10 (0=completely dissatisfied, 10=completely satisfied)
Time frame: 24 hours
Patient Satisfaction With Pain Control on Postoperative Day 7
Patient reported satisfaction with his/her pain control on postoperative day 7 on a scale of 0-10 (0=completely dissatisfied, 10=completely satisfied)
Time frame: Postoperative day 7
20 Meter Walk Test Time Performed on Postoperative Day 1
This standardized test measures the time it takes for the participant to walk 20 meters at their usual walking pace. The 20-meter walk test is a physical function measure commonly used in clinical research studies and rehabilitation clinics to measure gait speed and monitor changes in patients' physical function over time.
Time frame: On postoperative day 1