Analgesic Efficacy of Different Liposomal Bupivacaine Doses in the Adductor Canal Block for Total Knee Arthroplasty

Launched by THE UNIVERSITY OF HONG KONG · Dec 13, 2024

Keywords

ClinConnect Summary

This clinical trial is studying the effectiveness of different doses of liposomal bupivacaine, a medication used to manage pain, in a specific type of nerve block called the adductor canal block. This nerve block is given to patients undergoing total knee arthroplasty (TKA), a surgery often needed for severe knee arthritis. The goal is to find out which dose works best to reduce pain after surgery and to see if it helps patients use fewer opioid medications for pain relief. The trial will also look at how well patients recover and their knee function after the surgery.

To be eligible for this trial, participants need to be between 18 and 80 years old and scheduled for a single knee replacement surgery. They should be in generally good health, and able to understand and communicate in Cantonese, Mandarin, or English. However, certain conditions may exclude someone from participating, such as having a history of chronic pain, certain allergies, or other serious health issues. Participants in the trial can expect to receive different doses of the medication during their surgery, and their pain levels, recovery, and overall knee function will be monitored afterward. This study aims to provide clearer answers on how to best manage pain for patients undergoing knee replacement surgery.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • ASA I-III
• • Age 18-80 years old
• • Scheduled for elective primary unilateral total knee arthroplasty (TKA) with robotic surgery
• • Able to speak and understand Cantonese or Mandarin or English
• • Able to provide informed oral and written consent
• Exclusion Criteria:
• • Revision TKA
• • Single-stage bilateral TKA
• • Complex primary TKA requiring use of stem/augment/constrained liner
• • Surgeries with significant intraoperative complications which may alter rehabilitation protocol eg collateral ligament injury, fracture requiring fixation
• • Known allergy to opioids, local anaesthetic drugs, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDS) including COX-2 inhibitors
• • History of chronic pain other than chronic knee pain
• • History of immunosuppression
• • Chronic use of glucocorticoids
• • Chronic opioid use (morphine, fentanyl, hydromorphone, ketobemidone, methadone, nicomorphine, oxycodone, or meperidine)
• • History of congestive heart failure (NYHA 2)
• • Alcohol or drug abuse
• • Impaired renal function (defined as effective glomerular filtration rate \< 30ml/min/1.73m2
• • Impaired liver function (defined as plasma bilirubin over 34mol/L; international normalized ratio \[INR\] \>= 1.7, alanine aminotransferase \[ALT\] over 100U/L, aspartate aminotransferase \[AST\] over 100U/L)
• • Coagulopathy (platelet count \<100,000/ml and/or INR \>= 1.5) or the use of anticoagulants (not including aspirin) that precludes the use of adductor canal blocks
• • Pre-existing neurological or muscular disorders
• • Psychiatric illness
• • Impaired mental state
• • Pregnancy
• • Local infection
• • On immunosuppressants
• • High body mass index (BMI) (\>=40)
• • Patient refusal for regional nerve blocks or to conduct clinical trial