Intra-Operative Adductor Canal Blocks

A Randomized Controlled Trial Assessing the Efficacy of Surgeon-performed, Intraoperative Adductor Canal Blocks in Same-Day Discharge Total Knee Arthroplasty

Adductor canal blocks (ACB) have been recommended in total knee arthroplasty (TKA) to provide better control of post-operative pain, facilitate early ambulation, and reduce length of stay in the hospital. ACB is typically done before surgery by an anesthesiologist, which may increase time per case, cost, and requires the specialized skills of an anesthesiologist trained in regional anesthesia. Recent studies have suggested that surgeons can safely and reliably administer the adductor canal blocks (sACB) during surgery. However, there is currently very limited data on the clinical efficacy of such sACBs, and no studies assessing this technique in the context TKA that are discharged the same day. As such, this randomized control trial (RCT) is being done to compare sACBs to conventional anesthesiologist-performed adductor canal blocks (aACB).

The patient will undergo a pre-operative single-shot, ultrasound-guided ACB performed by an anaesthesiologist skilled in regional anaesthesia techniques. The ACB will be performed in a dedicated block room, immediately prior to administration of a spinal anaesthetic.

The patient will undergo an intraoperative single-shot ACB performed by the treating surgeon following placement of the TKA components.

Difference in scores on the Oxford knee score (questionnaire), rated from 0-48 with 48 being the best functional outcome and 0 being the worst

Difference in scores on the EQ-5D-5L questionnaire (Euro Quality of Life, 5 Dimension, 5 Level), rated from 11111 - 55555, with 11111 being full health and 55555 being worst health

Difference in scores on the PROMIS-10 - Global Health (questionnaire), which generates T-scores. Higher T-scores indicate better health.

Inclusion Criteria: Male and female patients aged 18 years or older Primary TKA booked as SDD Diagnosis of osteoarthritis Exclusion Criteria: Inability or refusal to sign informed consent form Non-English or French speaking, and no licensed translator, family member or substitute decision maker available. Non-osteoarthritis primary diagnosis Allergy to analgesic medications Contraindication to spinal and/or regional anaesthesia Any use of opioid pain medication within four weeks of the index procedure(13) Pain catastrophizing scale score ≥16 (8, 9, 14) History of cirrhosis History renal insufficiency History or sensory and/or motor neuropathy to the ipsilateral limb Simultaneous, bilateral TKA Non-TKA prosthesis Scheduled for non-SDD TKA. Preoperative varus/valgus of >10 degrees. Planned General Anaesthetic Use of Intrathecal Morphine