Effectiveness of Adductor Canal Block Using Liposomal Bupivacaine
Status:
Recruiting
Trial end date:
2021-10-01
Target enrollment:
Participant gender:
Summary
Due to population ageing, osteoarthritis of knees and hips become major orthopaedic problems
in Hong Kong. Osteoarthritis of knees and hips are associated with significant pain problems
and functional disability. Total joint replacement is the ultimate surgical procedure to deal
with these problems.
However, total joint replacement is associated with significant tissue damage and
post-operative pain problems, which would affect post-operative recovery and rehabilitation.
The primary aims of total knee replacement are improvement in functional activities and
reducing pain due to degenerated knee joints. However, there are around 20-30% of patients
who would develop significant pain problems after undergoing uncomplicated total knee
replacement. It accounts for major post-operative problems and burdens.
Procedure-specific analgesic method with multi-model analgesia technique is well-known to be
useful in post-operative pain management, which reduces the post-operative pain score.
Despite the use of multi-modal analgesic technique, pain after total joint replacement
remains unsolved. It prolongs the recovery period and increases post-operative analgesic
consumption.
Multimodal analgesia which includes periarticular local infiltration of analgesia (LIA),
regional nerve block, opioid and non-opioid have been shown to be effective in managing
postoperative pain.
Periarticular LIA has been shown to be an effective way of pain management. Regional nerve
block using femoral nerve block or adductor canal block (ACB) is also a well-established
anlagesic technique for total knee replacement. Compared with femoral nerve block, it
involves more sensory blockade. Hence, it has the advantage of quadriceps sparing. Moreover,
post-operative mobilization is less affected.
Recent meta-analysis and systemic review suggests that periarticular LIA is associated with
better pain control and reduced opioid consumption compared to using ACB alone. However,
duration of action and efficacy of a single-dose LIA may not be sufficient for total knee
replacement. Whether the combination use of ACB and periarticular LIA has additional benefit
of prolonging analgesia or comes with synergistic effect remains controversial. Although
recent meta analysis has shown that combined ACB with LIA could significantly reduce pain
score and morphine consumption compared with LIA alone after TKA, only 7 RCTS were involved
in this analysis. It is essential to have more RCTs to further evaluate the usefulness of
combining both LIA and ACB.
Plain bupivacaine or ropivocaine were used in ACB in all previous studies. They are local
anaesthetics with half-life ranging from 3-6 hours. With the availability of liposomal
bupivacaine, analgesic effect of ACB may be prolonged. It is because the therapeutic level of
bupivacaine is below the toxic range and sustained for 72 hours after injection. Only one
study evaluated the effect of adductor canal block using liposomal bupivacaine. However, it
was a retrospectively study which compared ACB using liposomal bupivacaine and 0.1 %
Ropivociane infusion. It didn't evaluate the efficacy of combining ACB using LB and
periarticular LIA.
The primary aim of this study is to investigate the efficacy of combining periarticular local
infiltration of analgesia and adductor canal block using liposomal bupivacaine