ESRA19-0442 Adductor canal block in an enhanced recovery program after total knee arthroplasty

Background and aims Total knee arthroplasty (TKA) is a painful procedure. In our hospital the worst pain appears in postoperative day one, which could be related to the use of an effective but short analgesic intraoperative technique: a periarticular local analgesic infiltration associated with NSAIDs and rescue opioids. The aim of this study is to assess if adductor canal block (ACB) performed the day after TKA improves analgesia without motor blockade and impairment of ambulation ability. Methods The trial is registered at http://www.clinicaltrials.gov (NCT03915522) and approved by the Regional Ethics Committee. This is a prospective, double-blinded study that includes patients ASA I-III, aged 18–85 years, admitted for TKA. Exclusion criteria are daily intake of strong opioids, allergy to drugs used and surgery performed under general anesthesia. Patients are transferred the day after the surgery to postoperative resuscitation unit. A sterile dressing of the extremity is performed, and after the adductor canal is identified with ultrasound, a puncture is done with or without doing the ACB. After all patients have a sterile apposite on the puncture site. Outcome measures are postoperative pain score measured with a numerical rating scale, knee extensor and adductor muscle strength measured using a hand-held dynamometer, ability to walk with ten meter walk test, rate of opioid side effects, rate of adductor canal block complications and length of hospital stay. Results The study is in recruiting status. The estimated number of patients enrolled is 140 and the estimated primary completion date September 2019. Conclusions In TKA it is essential to treat pain without motor leg impairment.