Location of Injection of Local Anesthetics in the Adductor Canal Block (LILAC)

February 25, 2019 updated by: Women's College Hospital

Location of Injection of Local Anesthetics in the Adductor Canal Block: A Randomized Controlled Trial of the Effect on Postoperative Analgesia and Motor Power

The adductor canal block (ACB) is the standard of care for analgesia after Anterior Cruciate Ligament (ACL) repair. ACB is performed by injecting local anesthetic (freezing) in the subsartorial canal in the thigh which is about 7-10cm long. Preliminary evidence suggests that different injection sites within the canal may produce different degrees of analgesia and quadriceps motor block. This trial seeks to determine the effects of various ACB injection sites on postoperative analgesia and motor power following ACL repair.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Adductor canal block (ACB) is replacing femoral nerve block (FNB) as the peripheral nerve block of choice for knee surgery. The ACB aims to inject local anesthetics (LA) within the neurovascular sheath in the subsartorial adductor canal around the femoral nerve. The point where the sartorius muscle crosses over the femoral artery is generally the accepted site for performing ACB. Clinically, injecting LA in the adductor canal blocks the sensory innervation of the knee and thus offers pain relief that is similar to FNB while conserving motor power around the knee. While these benefits are desirable, the exact location for performing ACB that ensures these benefits, remains debatable. The subsartorial adductor canal itself is 7-10cm long and the anatomical location of the sensory and motor nerves that innervate the knee and its surrounding muscles in this canal may vary. This randomized controlled trial is designed to identify and refine the ACB technique by clinically determining the effects of various ACB injection locations on postoperative analgesia and quadriceps motor power following ACL repair.

Study Type

Interventional

Enrollment (Actual)

108

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • Toronto, Ontario, Canada, M5S 1B2
        • Women's College Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

14 years to 46 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients booked for anterior cruciate ligament surgery under general anesthesia
  • English speaking
  • BMI <38 kg/m2

Exclusion Criteria:

  • Refusal or inability to provide informed consent
  • Allergy to local anesthetics
  • Contraindication to regional anesthesia including coagulopathy or bleeding - diathesis
  • Infection
  • Nerve Injury at the site of the nerve block
  • Malignancy at the site of the nerve block
  • History of drug and/or alcohol dependence
  • History of long term opioid intake or chronic pain disorder
  • History of pre-existing neuropathy in the operative leg
  • History of significant psychiatric conditions that may affect patient assessment
  • Inability to understand the informed consent and demands of the study
  • Allergy to any of the components of multi-modal analgesic regimen
  • Revision ACL repair

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Adductor Canal Block- Injection -Site A
AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site A - after the sartorius muscle crosses over the femoral artery
Drug: lidocaine
Local anesthetic
Other Names:
  • Xylocaine
Drug: ropivacaine
Local anesthetic
Other Names:
  • Naropin
Active Comparator: Adductor Canal Block - Injection -Site B
AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site B - before the sartorius muscle crosses over the femoral artery
Drug: lidocaine
Local anesthetic
Other Names:
  • Xylocaine
Drug: ropivacaine
Local anesthetic
Other Names:
  • Naropin
Active Comparator: Adductor Canal Block -Injection -Site C
AC Block-Injection (lidocaine 2% and ropivacaine 1%) Site C - as the sartorius muscle crosses over the femoral artery
Drug: lidocaine
Local anesthetic
Other Names:
  • Xylocaine
Drug: ropivacaine
Local anesthetic
Other Names:
  • Naropin

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cumulative 24 Hour Oral Morphine Equivalent Consumption
Time Frame: 24 hours
Post-Operative Analgesia
24 hours
Motor Power - Peak Force as measured by a dynamometer
Time Frame: 30 Minutes post Block
Percentage decrease in quadriceps motor strength at 30 minutes following adductor canal block compare to baseline
30 Minutes post Block

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Opioid Consumption
Time Frame: During surgical procedure
Intra-operative opioid consumption
During surgical procedure
Total opioids in Post Anesthetics (PAC)
Time Frame: Total length of time in PACU (total time in minutes from arrival in PACU to discharge to the Surgical Day Care is between 60-180 minutes
Cumulative oral morphine equivalent consumption in PACU
Total length of time in PACU (total time in minutes from arrival in PACU to discharge to the Surgical Day Care is between 60-180 minutes
Pain Scores - Questionnaire
Time Frame: 24 hours post block
Area under the curve for rest pain scores plotted against time during the first 24 hours
24 hours post block
Quality of Recovery (QoR-15)
Time Frame: 24 hours postoperatively
Quality of recovery measured using the QoR-15 at 24 hours postoperatively
24 hours postoperatively
Patient Satisfaction - Questionnaire
Time Frame: 24 hours postoperatively
Patient satisfaction with analgesia - NRS Pain Scale 0(no pain to 10(worst pain)
24 hours postoperatively
Hospital Discharge (Time to hospital discharge)
Time Frame: Same day as surgical procedure
Time to hospital discharge
Same day as surgical procedure
Nerve Block Complications
Time Frame: 24 hours postoperatively and 2 weeks postoperatively
Presence/absence of nerve block complications during the first 24 hours postoperatively and 2 weeks after surgery
24 hours postoperatively and 2 weeks postoperatively

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Women's College Hospital

Investigators

  • Principal Investigator: Richard Brull, MD, University of Toronto, Women's College Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 22, 2016

Primary Completion (Actual)

December 15, 2017

Study Completion (Actual)

January 2, 2018

Study Registration Dates

First Submitted

September 9, 2015

First Submitted That Met QC Criteria

September 17, 2015

First Posted (Estimate)

September 18, 2015

Study Record Updates

Last Update Posted (Actual)

February 27, 2019

Last Update Submitted That Met QC Criteria

February 25, 2019

Last Verified

February 1, 2019

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2015-0046-B

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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