The use of periarticular injection and adductor canal block are well-established techniques used both in combination or in isolation in the management of postoperative pain for patients undergoing total knee arthroplasty. The aim of this study is to investigate whether combining these two techniques have an added benefit, compared to periarticular injection alone, with respect to quality of recovery, functional return, discharge readiness, and short and long term post-operative narcotic use.
This study is a double blinded, randomized control trial. In order to create a blinded study, each participant will receive two injections; a single shot adductor canal block (ACB) and a periarticular injection (PI). All syringes will be non-identifiable to the surgeon, anesthetist and the patient. Specifically, the two arms are: Arm 1: PI (Ropivacaine + Ketorolac + Epinepherine) + ACB (Ropivacaine) Arm 2: PI (Ropivacaine + Ketorolac + Epinepherine) + ACB (Normal Saline) The aim of this study is to investigate whether combining these two techniques have an added benefit, compared to periarticular injection alone. The investigators hypothesize that the addition of an adductor canal block will translate to a superior quality of recovery, as well as an improvement in functional return, discharge readiness and less short-term and long-term post-operative narcotic use.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
60
As previously described.
As previously described.
Health Sciences North
Greater Sudbury, Ontario, Canada
Scoring on the Quality of Recovery-15 Survey
The Quality of Recovery-15 Survey is a validated patient-reported outcome questionnaire that measures the quality of recovery after surgery and anaesthesia. The 11-point numerical rating scale leads to a minimum score of 0 (very poor recovery) and a maximum score of 150 (excellent recovery). To be completed pre-operatively, and on POD#1, POD#10, and POD#28.
Time frame: Up to 4 weeks post-operatively.
Feasibility Outcomes
Defined by eligibility, recruitment rate, adherence to intervention protocol, percentage of completed outcome measures, participant retention
Time frame: End of project
Postoperative Pain
Pain will be assessed using the numeric rating scale (NRS) - an eleven point scale from 0 (no pain) to 10 (worst pain imaginable) - at rest and with movement. To be completed twice daily while in hospital.
Time frame: Throughout hospital stay, an average of 1-2 days.
Range of Motion
To be assessed by physiotherapy personnel twice daily while in hospital.
Time frame: Throughout hospital stay, an average of 1-2 days.
Time to Meet Discharge Criteria
Discharge criteria will be assessed by physiotherapy personnel and will include the ability to transfer in and out of bed independently, the ability to transfer on and off the toilet independently, the ability to ambulate independently with or without an assistive device for 50 meters, and the ability to do stairs if they are present in the patient's home environment. Time to meet discharge will be reported in half days. To be completed twice daily while in hospital.
Time frame: Throughout hospital stay, an average of 1-2 days.
Narcotic Consumption
In hospital opioid consumption will be recorded and tracked by nursing personnel and will be assessed twice daily while in hospital. Post-discharge opioid consumption will be assessed using a questionnaire that will be administered by the Research Assistant over the phone. Corroboration of patient report will be completed by the Pharmacy Department. Post-discharge opioid consumption will be tracked on POD #10 and POD#28.
Time frame: Up to 4 weeks post-operatively.
Timed Up and Go (TUG) Test
To be assessed by physiotherapy personnel twice daily while in hospital.
Time frame: Throughout hospital stay, an average of 1-2 days.
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