sACB vs cACB in TKA

Официальное название

Comparison of Single-shot vs. Continuous Adductor Canal Block Analgesic Effects With Catheter Positioning Confirmation in Total Knee Arthroplasty: a Double-blinded Prospective Randomized Controlled Trial

Обзор

This study compares the analgesic efficacy of single-dose adductor canal block (sACB) versus continuous-dose adductor canal block (cACB) for postoperative pain management in total knee replacement patients. To ensure a high level of clinical accuracy, the investigation specifically focuses on a cACB cohort where ultrasound confirmation ensures the catheter remains correctly positioned for a full 48 hours. Participants are assigned to groups using a 1:1 randomization protocol via computer-generated tables to eliminate selection bias. Clinical consistency is maintained by using identical pharmacological agents across both groups: 0.5% Heavy Bupivacaine for spinal anesthesia and 0.5% ropivacaine with 1:200,000 epinephrine for the nerve block itself. Furthermore, both groups adhere to a standardized multimodal analgesic schedule to control for external variables. In the cACB group, intravenous patient-controlled analgesia (IV PCA) serves as a designated rescue therapy should the catheter fail. The primary technical evaluation occurs 48 hours post-surgery, utilizing ultrasound to verify catheter placement and quantify pain levels. Beyond immediate recovery, the study evaluates long-term success through Patient-Reported Outcome Measures (PROMs) at a 12-week follow-up, focusing on functional restoration and the patient's overall quality of life. By isolating the variable of catheter stability, the research aims to provide a definitive comparison of whether the continuous delivery of local anesthetic offers a statistically significant clinical advantage over a single-dose administration in the context of modern orthopedic recovery protocols.

Вмешательства

• Процедура Continuous ACB
  Adductor canal block, a lower extremity nerve block technique for postoperative pain control, is performed under ultrasound guidance for patients undergoing total knee arthroplasty, and is carried out by inserting a catheter. The catheter is connected to a PCA pump following insertion, with a continuous infusion rate for two days post-surgery.
• Процедура Single-shot ACB
  Adductor canal block, a lower extremity nerve block technique for postoperative pain control, is performed under ultrasound guidance for patients undergoing total knee arthroplasty, and is carried out by a single-shot local anesthetic administration.

Первичные конечные точки

• postoperative pain score at rest (Area Under Curve, AUC) [Срок оценки: postoperative 48 hours]

Критерии участия

Критерии включения

• Age 40-80 yrs
• Scheduled for unilateral total knee arthroplatsy
• ASA I-III
• BMI 18-35 kg/㎡
• Able to read and understand consent form

Критерии исключения

• Allergy to local anesthetics
• Infection at the block site
• History of neuropathy or peripheral nerve disease
• Coagulation disorders or use of anticoagulants (if discontinuation is not possible)
• Communication disorders or cognitive impairment
• Chronic opioid use (≥30 MME/day, 3 months or more)
• Severe chronic pain (NRS ≥7/10, 3 months or more)
• Renal impairment (eGFR <30 mL/min/1.73m²)
• Hepatic impairment (Child-Pugh C)
• Blood coagulation disorders
• Pregnancy

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Идентификаторы

NCT: NCT07581886 · 4-2026-0299

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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