Total knee arthroplasty (TKA) is associated with moderate to severe pain after operation. There are twenty thousand patients undertaking TKA annually in Taiwan, and the average length of hospital stay is about seven to ten days. In contrast, the length of hospital stay is only three to six days in some literatures. Adequate pain relief after surgery allows patients to mobilize earlier and easier and rehabilitate to reduce the length of hospital stay. By reducing hospital stay, we can reduce medical expenditure of national health insurance. In addition, effective analgesia can reduce the occurrence of chronic post-surgical pain which would compromise life quality and produce socioeconomic problems. This study tries to find a better solution for postoperative analgesia of TKA for patients in Taiwan. The present clinical study compares the effect of adductor canal block and local infiltration on postoperative analgesia and functional activity after TKA. To assess the outcome of both methods in the same patient, we can have more comparative result of pain score and functional parameters like range of motion of knee joint, time and ability to ambulate. Based on that, we try to find a better option for postoperative analgesia for patients receiving TKA in Taiwan.
Total knee arthroplasty (TKA) is associated with moderate to severe pain after operation. There are twenty thousand patients undertaking TKA annually in Taiwan, and the average length of hospital stay is about seven to ten days. In contrast, the length of hospital stay is only three to six days in some literature. Some patients choose to receive bilateral TKA simultaneously to avoid repetitive surgery and anesthesia, and are supposed to suffer more than those receiving unilateral TKA. Adequate pain relief after surgery allows patients to mobilize earlier and easier and rehabilitate to reduce the length of hospital stay and postoperative complications. By reducing the length of in-hospital stay and post-operative complication, we can reduce medical expenditure of national health insurance. In addition, effective analgesia can reduce the occurrence of chronic post-surgical pain which would compromise life quality and produce socioeconomic problems. This study tries to find a better solution for postoperative analgesia of TKA for patients in Taiwan. The present clinical study compares the effect of adductor canal block and local infiltration on postoperative analgesia and functional activity after bilateral simultaneous TKA. To assess the outcome of both methods in the same patient, we can have more comparative result of pain score and functional parameters like range of motion of knee joint, muscle power in knee adduction/abduction movement, and time and ability to ambulate. Based on that, we try to find a better option for postoperative analgesia for patients receiving TKA in Taiwan.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
64
As the primary outcome of the present clinical study, pain scores will be assessed with numerical rating scale at both rest and motion on both knees.
Brief Pain Inventory (Short Form), WOMAC Osteoarthritis index, and Lower extremity functional scale will be used as the questionnaires for functional assessment. Rehabilitation physiotherapy will be assessed with knee range of motion (both active and maximal passive), muscle power at abduction and adduction, single leg stance test, six-minute walk test for assessment of the functional recovery of knee joints.
Taipei Veterans General Hospital
Taipei, Taiwan
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Baseline (the day before surgery)
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Hour 2 after surgery
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Hour 8 after surgery
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Hour 24 after surgery
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Hour 36 after surgery
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Hour 48 after surgery
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Hour 60 after surgery
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Hour 72 after surgery
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: The day of discharge
Pain score
Assess the pain intensity with numerical rating scale both at rest and motion in each knee. A 11 point (0-10) numerical rating scale defines 0 as no pain and 10 as the worst pain imaginable,
Time frame: Month 3 after surgery
Knee range of motion
Maximal range of motion at both continuous passive motion and active motion will be assessed with protractor (degrees)
Time frame: Baseline (the day before surgery)
Knee range of motion
Maximal range of motion at both continuous passive motion and active motion will be assessed with protractor (degrees)
Time frame: Hour 24 after surgery
Knee range of motion
Maximal range of motion at both continuous passive motion and active motion will be assessed with protractor (degrees)
Time frame: Hour 72 after surgery
Knee range of motion
Maximal range of motion at both continuous passive motion and active motion will be assessed with protractor (degrees)
Time frame: the day of discharge
Knee range of motion
Maximal range of motion at both continuous passive motion and active motion will be assessed with protractor (degrees)
Time frame: Month 3 after surgery
Knee muscle power
Both adduction and abduction muscle power on both knees will be assessed with Commander Echo Algometry (pounds)
Time frame: Baseline (the day before surgery)
Knee muscle power
Both adduction and abduction muscle power on both knees will be assessed with Commander Echo Algometry (pounds)
Time frame: Hour 24 after surgery
Knee muscle power
Both adduction and abduction muscle power on both knees will be assessed with Commander Echo Algometry (pounds)
Time frame: Hour 72 after surgery
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Knee muscle power
Both adduction and abduction muscle power on both knees will be assessed with Commander Echo Algometry (pounds)
Time frame: the day of discharge
Knee muscle power
Both adduction and abduction muscle power on both knees will be assessed with Commander Echo Algometry (pounds)
Time frame: Month 3 after surgery
Six minute walk test
To assess the walk ability (6-minute walk distance) before and after TKA surgery (meters)
Time frame: Baseline (the day before surgery)
Six minute walk test
To assess the walk ability (6-minute walk distance) before and after TKA surgery (meters)
Time frame: Hour 24 after surgery
Six minute walk test
To assess the walk ability (6-minute walk distance) before and after TKA surgery (meters)
Time frame: Hour 72 after surgery
Six minute walk test
To assess the walk ability (6-minute walk distance) before and after TKA surgery (meters)
Time frame: the day of discharge
Six minute walk test
To assess the walk ability (6-minute walk distance) before and after TKA surgery (meters)
Time frame: Month 3 after surgery
Single leg stance test
To assess the stance ability and static postural and balance control on one leg without help either with eyes opened or closed before and after TKA surgery (assessed as seconds)
Time frame: Baseline (the day before surgery)
Single leg stance test
To assess the stance ability and static postural and balance control on one leg without help either with eyes opened or closed before and after TKA surgery (assessed as seconds)
Time frame: Hour 24 after surgery
Single leg stance test
To assess the stance ability and static postural and balance control on one leg without help either with eyes opened or closed before and after TKA surgery (assessed as seconds)
Time frame: Hour 72 after surgery
Single leg stance test
To assess the stance ability and static postural and balance control on one leg without help either with eyes opened or closed before and after TKA surgery (assessed as seconds)
Time frame: the day of discharge
Single leg stance test
To assess the stance ability and static postural and balance control on one leg without help either with eyes opened or closed before and after TKA surgery (assessed as seconds)
Time frame: Month 3 after surgery
Functional questionnaires
Functional pain scale will be assessed with Western Ontario and McMaster Universities Osteoarthritis Index, Brief pain inventory (BPI) short form, and Lower extremity functional scale
Time frame: Baseline (the day before surgery)
Functional questionnaires
Functional pain scale will be assessed with Western Ontario and McMaster Universities Osteoarthritis Index, Brief pain inventory (BPI) short form, and Lower extremity functional scale
Time frame: the day of discharge
Functional questionnaires
Functional pain scale will be assessed with Western Ontario and McMaster Universities Osteoarthritis Index, Brief pain inventory (BPI) short form, and Lower extremity functional scale
Time frame: Month 3 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Baseline (the day before surgery)
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Hour 2 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Hour 8 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Hour 24 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Hour 36 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Hour 48 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Hour 60 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Hour 72 after surgery
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: the day of discharge
Adverse events
Adverse events will be assessed with items including nausea, vomiting, somnolence, dizziness, urinary retention, skin itch, respiratory depression, and lower limb weakness, numbness, and allodynia
Time frame: Month 3 after surgery