Effects of Catheter Location on Postoperative Analgesia for Continuous Adductor Canal and Popliteal-Sciatic Nerve Blocks
Post-surgical Pain, Total Knee Arthroplasty, Foot/Ankle Surgery
About this trial
This is an interventional treatment trial for Post-surgical Pain focused on measuring moderate pain, severe pain, surgery, postop analgesia, TKA, adductor catheter, poplital catheter, foot/ankle surgery
Eligibility Criteria
Inclusion Criteria:
- undergoing surgery with an adductor canal or popliteal-sciatic perineural catheter for postoperative analgesia following primary tri-compartment knee arthroplasty or foot/ankle surgery;
- anticipated to have at least moderate pain following surgery [NRS>3]; and,
- age 18 years or older.
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;
- clinical neuropathy in the surgical extremity;
- 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 > 40 kg/m2;
- allergy to study medications (lidocaine, ropivicaine);
- known renal insufficiency; or,
- incarceration.
Sites / Locations
- University California San Diego
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
proximal catheter insertion
distal catheter insertion
Adductor canal catheters: Inserted as described by Jæger et al., 2013: "…we performed an ultrasound survey at the medial part of the thigh, halfway between the superior anterior iliac spine and the [superior border of the] patella. In a short axis view, we identified the femoral artery underneath the sartorius muscle, with the vein just inferior and the saphenous nerve just lateral to the artery." Popliteal catheters: Using an ultrasound, the bifurcation of the sciatic nerve will be identified in short axis and marked at a point immediately distal at which point the two main branches of the sciatic nerve are separate and a hypoechoic area can be viewed between the two. This level will be marked on the skin. The needle will be inserted to intersect the sciatic nerve 6-7 cm proximal to the mark on the skin (therefore, proximal to the sciatic bifurcation) and injection with saline used to ensure subepimyseal spread.
Adductor canal catheters: Inserted as described by Manickam et al. 2009 Popliteal catheters: Using an ultrasound, the bifurcation of the sciatic nerve will be identified in short axis and marked at a point immediately distal at which point the two main branches of the sciatic nerve are separate and a hypoechoic area can be viewed between the two. This level will be marked on the skin. The needle tip will be inserted into the hypoechoic area between the two branches of the sciatic nerve immediately distal to the sciatic nerve bifurcation between the paraneurium and epineurium (the subparaneural space/compartment). As described by Tran et al, "An adequate position was defined as the presence of circular expansion of the paraneural sheath... Once circular expansion was obtained, we injected."