Effectiveness of iPACK on Postoperative Pain From Hamstring Autograft Following ACL Repair

Brenton Alexander40 enrolled

Overview

Patients undergoing ACL repair with hamstring autograft frequently develop significant post operative pain at the hamstring grafting site. This pain is within the distribution of a commonly used regional nerve block, the Interspace between the popliteal artery and capsule of the knee (iPACK). The investigators plan to randomize consenting patients to either receiving a SHAM injection of normal saline or to an interventional group of long acting local anesthetic (Ropivacaine) injected in the popliteal fossa between the popliteal artery and capsule of the knee (iPACK). Both groups of patients will receive standard of care with respect to perioperative pain management, which includes a preoperative adductor canal nerve block and preoperative acetaminophen administration. Dual primary endpoints of postoperative pain scores and mean postoperative opioid use will be retrieved and compared between groups. Additional secondary endpoints will be PACU length of stay, PACU opioid use, POD1 opioids use, and POD1 pain scores (best, worst, average).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Pain, Postoperative ACL Injury Anesthesia, Local

Interventions

Ropivacaine iPACK InjectionPROCEDURE

Injection of 20mL of 0.25% Ropivacaine with 1:400,000 Epinephrine between in the Interspace between the Popliteal Artery and the Capsule of the Knee (iPACK) using ultrasound guidance at the level of the femoral condyles

Normal Saline iPACK InjectionPROCEDURE

Injection of 20mL of 0.9% Normal Saline between in the Interspace between the Popliteal Artery and the Capsule of the Knee (iPACK) using ultrasound guidance at the level of the femoral condyles

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Undergoing ACL surgery with expected Hamstring Autograft by Dr. Catherine Robertson at UC San Diego * At least 18 years of age * Able to Provide Consent in English prior to Surgery Exclusion Criteria: * Pregnancy (a urine pregnancy test is standard at UCSD for female patients prior to menopause who are sexually active with the opposite sex within the previous year) * Inability to communicate with the investigators and hospital staff * Severe renal, hepatic or cardiac disease * Chronic high-dose opioid use (defined as daily use for more than 4 weeks prior to surgery of at least the equivalent of 20 mg oxycodone) * BMI \> 45 kg/m2 * Allergy to study medications (lidocaine, bupivacaine) * Incarceration.

Outcomes

Primary Outcomes

Median Post Anesthesia Recovery Unit (PACU) Pain Score

Median pain score collected in the PACU following surgery on a scale of 1-10 (1 being no pain, 10 being the worst pain the patient has ever experienced)

Time frame: From arrival in PACU until patient has been cleared for PACU discharge

Total Perioperative Opioid Use (Morphine equivalents)

Intraoperative and Post Operative (in the PACU) opioid use

Time frame: From time of the start of surgery until time that patient meets PACU discharge criteria

Secondary Outcomes

PACU Length of Stay (days)

Length of stay from PACU arrival to "ready for discharge" criteria are met

Time frame: From PACU arrival until criteria for PACU discharge are met

PACU Opioid Use (Morphine equivalents)

All opioid use in the PACU

Time frame: From PACU arrival until criteria for PACU discharge are met

Postoperative Day (POD) 1 Opioid Use (Morphine Equivalents)

All Opioid use in the approximate 24 hours following PACU Discharge

Time frame: Time of discharge from PACU until 24 hours after PACU discharge

Best, Worst, Average Pain Scores on POD 1

Best, Worst and Average pain scores collected on POD 1 following surgery on a scale of 1-10 (1 being no pain, 10 being the worst pain the patient has ever experienced)

Time frame: For the entire length of post operative day 1