ERAS Anesthesia Techniques for Knee Surgery Recovery (EKAT-TeleTPS Trial)
Recruiting in Palo Alto (17 mi)
Overseen ByDavid Kim, MD
Age: 18+
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Hospital for Special Surgery, New York
No Placebo Group
Trial Summary
What is the purpose of this trial?A comparison of two anesthetic techniques for total knee replacements: (1) Peri-Articular Injection (PAI), local infiltration between the popliteal artery and capsule of the knee block (IPACK) and single-shot adductor canal block (ACB) vs. (2) PAI, IPACK and continuous adductor canal block catheter (ACC).
What data supports the idea that ERAS Anesthesia Techniques for Knee Surgery Recovery is an effective treatment?The available research shows that the Adductor Canal Block (ACB) is effective in reducing pain after knee surgery. One study found that ACB provides good pain control for patients undergoing total knee replacement, although it may not relieve pain at the back of the knee. Another study showed that ACB helps reduce the need for pain medication like morphine after knee surgeries. Additionally, ACB is compared to another method called the femoral nerve block, and it is suggested that ACB might be better at controlling pain while allowing patients to keep their leg strength. Overall, these studies indicate that ACB is a useful treatment for managing pain after knee surgery.467813
Is the treatment Continuous Adductor Canal Catheter (ACC) promising for knee surgery recovery?Yes, Continuous Adductor Canal Catheter (ACC) is a promising treatment for knee surgery recovery. It provides effective pain control and helps patients move better after surgery compared to other methods like epidural analgesia. It is also considered a 'motor sparing' technique, meaning it controls pain without causing much muscle weakness, which is important for recovery.345712
What safety data exists for adductor canal block techniques in knee surgery recovery?The study titled 'The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty' provides safety data for adductor canal block (ACB) techniques. It assesses the feasibility and safety of DACB, a variation of ACB, when administered by surgeons as part of periarticular infiltration in total knee arthroplasty. This suggests that ACB and its variations are considered safe when performed under specific conditions.1291011
Do I need to stop my current medications for this trial?The trial protocol does not specify if you need to stop your current medications. However, if you are using gabapentin or pregabalin regularly for more than 3 months, you cannot participate in the trial.
Eligibility Criteria
This trial is for English-speaking adults aged 18-65 with osteoarthritis, scheduled for knee replacement surgery using regional anesthesia. They must live within an hour of the hospital, be able to follow the study protocol, have a smartphone, and have home caregivers if needed. Excluded are those with diabetes, chronic pain or high pain catastrophizing scores, severe knee deformities, no home caregivers for catheter care, ASA status III/IV patients, those unable to manage a catheter at home or going to rehab facilities post-surgery.Participant Groups
The trial compares two anesthesia techniques in knee replacements: one uses a single-shot nerve block plus local injections (PAI & IPACK), while the other adds a continuous nerve block through a catheter (ACC). The goal is to see which method provides better pain control during recovery.
2Treatment groups
Active Control
Placebo Group
Group I: Continuous Adductor Canal Catheter (ACC)Active Control1 Intervention
Patients will receive a combined spinal epidural, PAI, IPACK, and a continuous adductor canal catheter
Group II: Adductor Canal block with sham catheterPlacebo Group1 Intervention
Patients will receive a combined spinal epidural, PAI, IPACK, and an adductor canal block. The patient will also receive a sham catheter.
Adductor Canal block with sham catheter is already approved in European Union, United States, Canada for the following indications:
🇪🇺 Approved in European Union as Adductor Canal Block for:
- Postoperative pain management for knee surgery
🇺🇸 Approved in United States as Adductor Canal Block for:
- Postoperative pain management for knee surgery
🇨🇦 Approved in Canada as Adductor Canal Block for:
- Postoperative pain management for knee surgery
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
Hospital for Special SurgeryNew York, NY
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Who is running the clinical trial?
Hospital for Special Surgery, New YorkLead Sponsor
References
Anatomic endoscopic anterior cruciate ligament reconstruction with patella tendon autograft. [2022]Current tibial endoscopic ACL reconstruction techniques provide functional stability, but fall short of the ultimate goal of ACL reconstruction, to restore normal knee kinematics. Vertical graft placement results in restoration of normal anteroposterior stability with a negative Lachman exam, but may not produce a stable knee in rotation, noted by a positive pivot shift. The Clancy anatomic endoscopic ACL reconstruction technique utilizes flexible reamers to achieve anatomic graft placement to more closely reproduce normal knee function. The overall results of arthroscopic anatomic endoscopic ACL reconstruction are essentially the same as we have reported using our previous open and rear-entry, two-incision techniques for anatomic graft placement. The long-term benefits of a more physiologic single incision endoscopic ACL reconstruction are not yet determined; however, short-term results are encouraging.
Anterior Cruciate Ligament Reconstruction and Preservation: The Single-Anteromedial Bundle Biological Augmentation (SAMBBA) Technique. [2022]Preservation of the anterior cruciate ligament (ACL) remnant during ACL reconstruction has the advantages of improved vascularity and synovial encircling of the graft tendon. We describe a technique called single-anteromedial bundle biological augmentation (SAMBBA) using complete preservation of the ACL remnant, as well as preservation of the semitendinosus tibial insertion, that uses standard portals and equipment.
Adductor Canal Block With Bupivacaine Liposome Versus Ropivacaine Pain Ball for Pain Control in Total Knee Arthroplasty: A Retrospective Cohort Study. [2022]Appropriate postoperative pain control following total knee arthroplasty is important in patient recovery. Adductor canal block (ACB) is a novel method to deliver anesthesia. There are currently no studies using bupivacaine liposome with ACB while also taking into account cost.
A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique. [2022]Adductor canal blocks (ACBs) provide effective analgesia following total knee arthroplasty. We hypothesized that ACB single injection plus intravenous (IV) dexamethasone (Dex) shows non-inferiority to catheter, while ACB single injection does not.
Continuous Adductor Canal Blocks Provide Superior Ambulation and Pain Control Compared to Epidural Analgesia for Primary Knee Arthroplasty: A Randomized, Controlled Trial. [2022]Adductor canal blocks (ACBs) are an alternative to femoral nerve blocks that minimize lower extremity weakness. However, it is unclear whether this block will provide analgesia that is equivalent to techniques, such as epidural analgesia. The purpose of this randomized controlled trial was to compare continuous ACBs with epidural analgesia for primary total knee arthroplasty.
Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. [2022]Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves.
A Randomized Comparison of Pain Control and Functional Mobility between Proximal and Distal Adductor Canal Blocks for Total Knee Replacement. [2022]Adductor canal blocks (ACBs) have become a popular technique for postoperative pain control in total knee arthroplasty patients. Proximal and distal ACB have been compared previously, but important postoperative outcomes have yet to be assessed.
A randomised controlled trial comparing adductor canal block and femoral nerve block for knee arthroplasty. [2020]Adductor canal block (ACB) is hypothesised to provide superior analgesia to femoral nerve block (FNB) for total knee arthroplasty (TKA) while preserving quadriceps strength.
Femoral tunnel placement in single-bundle, remnant-preserving anterior cruciate ligament reconstruction using a posterior trans-septal portal. [2019]Anatomic tunnel formation and remnant preservation are valuable aspects of anterior cruciate ligament (ACL) reconstruction. However, anatomic landmarks are difficult to observe during remnant-preserving ACL reconstruction (ACLR). The aims of this study were to evaluate the: 1) femoral tunnel location created with guidance from the apex of the deep cartilage margin (ADC) and footprint compared to anatomical reference; and 2) relationship between femoral tunnel location and outcomes of ACLR.
Evaluating the Accuracy of Tibial Tunnel Placement After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. [2020]Anatomic anterior cruciate ligament (ACL) reconstruction improves knee kinematics and joint stability in symptomatic patients who have ACL deficiency. Despite a concerted effort to place the graft within the ACL's native attachment sites, the accuracy of tunnel placement using contemporary techniques is not well established.
The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty. [2020]Adductor canal block (ACB) is one of the preferred methods of analgesia in total knee arthroplasty (TKA). However, conventionally its use is time-consuming, requires ultrasound guidance, a trained anaesthesia team and adherence to strict asepsis by members of the allied teams. This study was done to assess the feasibility and safety of direct adductor canal block (DACB) as a part of surgeon-administered periarticular infiltration.
Evaluation of ultrasound-guided adductor canal block with two different concentration of bupivacaine in arthroscopic knee surgery: A feasibility study. [2022]The application of regional anaesthesia techniques as a component of multimodal analgesia in knee arthroscopic surgeries increases the quality of postoperative analgesia. Adductor canal block (ACB) is an effective "motor sparing" analgesia technique used in knee surgeries. This study aimed to evaluate the efficacy of ACB using two different concentrations of local anaesthetic in terms of analgesic requirements and pain density in patients undergoing knee arthroscopy.
Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial. [2023]Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block.