Pain Levels and Opioid Usage in Three Nerve Block Cohorts in Primary TKA

University of Louisville

Overview

The primary objective of this study is to compare effect of combined block of ACB (adductor canal block) with IPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee) block and/or Intra-articular block in immediate postoperative and early postop rehabilitation and pain management in patients undergoing primary TKA. The secondary objective is to review both in-hospital and post-discharge pain levels and narcotic usage of primary TKAs, with a minimum 6-week postoperative follow-up.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

SINGLE

Conditions

Knee Arthropathy

Interventions

preop ACB, followed by Intra-articular block during TKA surgeryOTHER

Preoperative ACB (adductor canal block), followed by a local anesthetic injection during surgery, which is comprised of the following agents and amounts: * Ropivacaine 5mg/ml (49.25ml) * Epinephrine 1mg/ml (0.5ml) * Ketorolac 30mg/ml (1ml) * Clonidine 0.1mg/ml (0.8ml) * Saline 48.45ml

preop ACB+IPACK blockOTHER

Preoperative ACB (adductor canal block) and IPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee) block

preop ACB+IPACK block, followed by Intra-articular block during TKA surgeryOTHER

Eligibility

Sex: ALLMin age: 22 YearsMax age: 89 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patient is indicated for a primary, unilateral TKA secondary to osteoarthritis. 2. Patient age is 22-89 at time of TKA surgery. 3. Patient agrees to participate as a study subject and signs the Informed Consent and Research Authorization document. 4. Patient is able to read and speak English. Exclusion Criteria: 1. Patient is under the age of 22 or over the age of 89. 2. Patient's primary diagnosis is not osteoarthritis (e.g. post-traumatic arthritis). 3. Patient is scheduled to undergo a bilateral TKA surgery. 4. Patient is unable to read and speak English.

Locations (1)

Jewish Hospital

Louisville, Kentucky, United States

Outcomes

Primary Outcomes

total length of hospital stay

total length of hospital stay as defined by number of days from date of surgery to date of discharge

Time frame: outcome measure will be taken at 2 weeks postoperatively

Knee Society Score

Knee Society Score as recorded preoperatively and 6 weeks (± 2 weeks) postoperatively. The score is on a scale from 0-100. A higher value represents a better outcome

Time frame: outcome measure will be taken preoperatively (4-6 weeks prior to date of surgery) and 6 weeks (± 2 weeks) postoperatively.]

WOMAC score

WOMAC score as recorded preoperatively and 6 weeks (± 2 weeks) postoperatively. The score is on a scale from 0-100. In contrast to the Knee Society Score, on the WOMAC a lower value represents a better outcome.

Time frame: outcome measure will be taken preoperatively (4-6 weeks prior to date of surgery) and 6 weeks (± 2 weeks) postoperatively

Visual Analog Scale

The Visual Analog Scale measures the patient's level of knee pain on a scale of zero to ten via what the patient expresses verbally. The Visual Analog Scale (VAS) represents the degree of pain that the patient is experiencing at the time the measure is taken. Zero represents "pain-free". A 10 would represent pain so excruciating as to warrant emergency medical assistance, or as it is described to the patient, "the worst pain imaginable". Obviously, the lower the number, the better the outcome. There is no subscale.

Time frame: outcome measure will be taken 24 hours postoperatively, 48 hours postoperatively, 72 hours postoperatively, 2 weeks (± 4 days) postoperatively, and 6 weeks (± 2 weeks) postoperatively

Amount of narcotic medication utilized

Amount of narcotic medication utilized (daily dosage measured as a Milligram Morphine Equivalent (MME) value).

Time frame: outcome measure will be taken 24 hours postoperatively, 48 hours postoperatively, 72 hours postoperatively, 2 weeks (± 4 days) postoperatively, and 6 weeks (± 2 weeks) postoperatively

Data from ClinicalTrials.gov

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