Intra-Operative Adductor Canal Blocks

A Randomized Controlled Trial Assessing the Efficacy of Surgeon-performed, Intraoperative Adductor Canal Blocks in Same-Day Discharge Total Knee Arthroplasty

Adductor canal blocks (ACB) have been recommended in total knee arthroplasty (TKA) to provide better control of post-operative pain, facilitate early ambulation, and reduce length of stay in the hospital. ACB is typically done before surgery by an anesthesiologist, which may increase time per case, cost, and requires the specialized skills of an anesthesiologist trained in regional anesthesia. Recent studies have suggested that surgeons can safely and reliably administer the adductor canal blocks (sACB) during surgery. However, there is currently very limited data on the clinical efficacy of such sACBs, and no studies assessing this technique in the context TKA that are discharged the same day. As such, this randomized control trial (RCT) is being done to compare sACBs to conventional anesthesiologist-performed adductor canal blocks (aACB).

Study Overview

• Status: Completed
• Conditions: Knee Osteoarthritis; Anesthesia; Knee Arthritis; Knee Pain Chronic
• Intervention / Treatment: Procedure: aACB; Procedure: sACB

• Study Type: Interventional
• Enrollment (Actual): 200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada
      • The Ottawa Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male and female patients aged 18 years or older
2. Primary TKA booked as SDD
3. Diagnosis of osteoarthritis

Exclusion Criteria:

1. Inability or refusal to sign informed consent form
2. Non-English or French speaking, and no licensed translator, family member or substitute decision maker available.
3. Non-osteoarthritis primary diagnosis
4. Allergy to analgesic medications
5. Contraindication to spinal and/or regional anaesthesia
6. Any use of opioid pain medication within four weeks of the index procedure(13)
7. Pain catastrophizing scale score ≥16 (8, 9, 14)
8. History of cirrhosis
9. History renal insufficiency
10. History or sensory and/or motor neuropathy to the ipsilateral limb
11. Simultaneous, bilateral TKA
12. Non-TKA prosthesis
13. Scheduled for non-SDD TKA.
14. Preoperative varus/valgus of >10 degrees.
15. Planned General Anaesthetic
16. Use of Intrathecal Morphine

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Anesthesiologist-Performed Adductor Canal Block (aACB); Patients will get a pre-operative adductor canal block performed by an anesthesiologist.	Procedure: aACB; The patient will undergo a pre-operative single-shot, ultrasound-guided ACB performed by an anaesthesiologist skilled in regional anaesthesia techniques. The ACB will be performed in a dedicated block room, immediately prior to administration of a spinal anaesthetic.
Experimental: Surgeon-Performed Adductor Canal Block (sACB); Patients will get an intra-operative adductor canal block performed by the surgeon	Procedure: sACB; The patient will undergo an intraoperative single-shot ACB performed by the treating surgeon following placement of the TKA components.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Report Pain	Mean Numerical Pain Rating Scale (NPRS) scores on discharge	Up to 24 hours
Pain medication use	morphine equivalents of pain medication	When spinal anesthesia resolves until 24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to discharge	Post-operative time in minutes to discharge home	From PACU to discharge
Admission to Hospital	Failure to discharge home requiring admission	Up to 24 hours post-operative
Readmission Rate	Number of patients readmitted to the hospital within 24 hours	Up to 24 hours post-operative
Timed Up and Go Test	Time is takes, in seconds, to stand, walk 3m, turn around, walk back 3m, and sit back down	At discharge
Patient Reported Quality of Recovery	Score on the Quality of Recovery-15 questionnaire	At 24 hours post-operative
Patient Reported Function	Difference in scores on the Oxford knee score (questionnaire), rated from 0-48 with 48 being the best functional outcome and 0 being the worst	pre-operatively, at 2 weeks post-operative
Patient Reported Quality of Life	Difference in scores on the EQ-5D-5L questionnaire (Euro Quality of Life, 5 Dimension, 5 Level), rated from 11111 - 55555, with 11111 being full health and 55555 being worst health	pre-operatively, at 2 weeks post-operative
Patient Reported Global Health	Difference in scores on the PROMIS-10 - Global Health (questionnaire), which generates T-scores. Higher T-scores indicate better health.	pre-operatively, at 2 weeks post-operative

Collaborators and Investigators

• Sponsor: Ottawa Hospital Research Institute
• Collaborators: Canadian Orthopaedic Foundation
• Investigators: Principal Investigator: Simon Garceau, MD, The Ottawa Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 22, 2023
• Primary Completion (Actual): October 13, 2025
• Study Completion (Actual): December 28, 2025

Study Registration Dates

• First Submitted: September 20, 2022
• First Submitted That Met QC Criteria: October 28, 2022
• First Posted (Actual): November 1, 2022

Study Record Updates

• Last Update Posted (Actual): May 27, 2026
• Last Update Submitted That Met QC Criteria: May 25, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: 20220573-01H

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No