To assess feasibility of a a trial investigation postoperative patient-reported quality of recovery after total knee arthroplasty (TKA) with periarticular joint injection (PAI) ± single shot adductor canal block with or without adductor canal catheter infusion.
Knee osteoarthritis (KOA) is a leading cause of chronic knee pain and disability, with a lifetime prevalence of 45%. Treatment for symptomatic KOA includes physical therapy, oral anti-inflammatory medications and intra-articular steroid injections, with total knee arthroplasty (TKA) (or knee replacement) as the definitive treatment. Acute postoperative pain is common after TKA, leading to increased opioid consumption and increased hospital length of stay. Pain control following TKA has been investigated with interventions such as intrathecal morphine, nerve blocks, and periarticular joint injection (PAI). PAI and adductor canal block are well-established techniques used both in combination or in isolation in the management of postoperative pain for patients undergoing TKA. The aim of this study is to assess postoperative patient-reported quality of recovery after TKA with PAI and single shot adductor canal block with or without adductor canal catheter infusion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
800 mg ropivacaine in continuous infusion adductor canal block (400 mL total volume)
400 mL normal saline in continuous infusion adductor canal block (400 mL total volume)
St Joseph's Healthcare Hamilton
Hamilton, Ontario, Canada
Quality of Recovery-15 Survey scores
Patient-reported Quality of Recovery scores, where higher scores indicate better quality of recovery
Time frame: Postoperative day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3
Quality of Recovery-15 Survey scores
Patient-reported Quality of Recovery scores, where higher scores indicate better quality of recovery
Time frame: Postoperative days 10 and 42
Brief Pain Inventory - Pain Interference scores
On a scale of 0-10, where 0=Does not interfere and 10=Completely interferes, Patients will rate how much their pain interferes with: General activity, Mood, Walking ability, Normal work including housework, Relations with other people, Sleep, and Enjoyment of life
Time frame: Postoperative days 1, 2 and 3 in the morning
Pain Numerical Rating Scale at rest
Patient-reported pain measured on an 11-point scale from 0 \[no pain\] to 10 \[worst pain imaginable\]
Time frame: Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3
Pain Numerical Rating Scale with activity
Patient-reported pain measured on an 11-point scale from 0 \[no pain\] to 10 \[worst pain imaginable\]
Time frame: Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 after physiotherapy
Functional Recovery: Range of motion
Flexion and Extension range of motion measured in degrees
Time frame: Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 after physiotherapy
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Functional Recovery: Time to reach discharge criteria
Physiotherapist to assess when patient meets discharge criteria (measured in half days)
Time frame: Postoperative Day 0 (2 hours postoperatively), and morning of postoperative days 1, 2 and 3 after physiotherapy
Functional Recovery: Timed Up and Go test
Time it takes for patient to stand up from sitting in a chair, walk 3 meters, then turn and walk back to chair and sit down, measured in seconds
Time frame: Postoperative day 42
Frequency of opioid-related side effects (vomiting and nausea)
Number of vomiting events or complaints of nausea noted in nursing notes
Time frame: Up to 3 days
Narcotic consumption in hospital
total amount and route of administration collected from routine and PRN opioid use in PACU and on surgical floor - measured in mg of oral morphine equivalence
Time frame: Up to 3 days
Narcotic consumption at home
Post-discharge opioid consumption will be tracked with pill count on POD 1 or 2, 3 POD10 (± 2 days), and POD42 (± 2 days); on POD 42 - patient to show study nurse how many pills remain to ensure reporting accuracy
Time frame: Postoperative day 42
Complications
i. return to hospital once discharged for non-analgesic reasons ii. require more pain medications outside of prescription given
Time frame: Postoperative days 10 and 42