Clinical Practice of Hydromorphone in Multimodal Analgesia for Enhanced Recovery After Surgery (ERAS) in Knee Arthroplasty

Hydromorphone as an Adjuvant to Ropivacaine for Adductor Canal Block in Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind, Controlled Trial

This study proposes a multimodal analgesia regimen comprising preoperative non-steroidal anti-inflammatory drugs (NSAIDs) for preemptive analgesia, intra-articular injection at the end of surgery, and postoperative adductor canal block. The objective is to observe the analgesic efficacy and duration of hydromorphone combined with ropivacaine in the adductor canal block on resting and movement-related pain in patients following total knee arthroplasty, as well as the time to recovery from motor blockade and the incidence of drug-related adverse events.

Study Overview

• Status: Completed
• Conditions: Quadriceps Strength; VAS Score
• Intervention / Treatment: Drug: Ropivacaine; Drug: Ropivacaine + Hydromorphone

• Study Type: Interventional
• Enrollment (Actual): 90
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100029
      • China-Japan Friendship Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. ASA physical status I-III;
2. Undergoing elective unilateral primary total knee arthroplasty (TKA);
3. Implementing the ERAS protocol
4. Body-mass index (BMI) of 18.5-32.0 kg/m²;
5. Provided written informed consent.

Exclusion Criteria:

1. Allergy to amide local anaesthetics or opioids;
2. Chronico or disorder opioid use;
3. Pre-existing central and peripheral nerve injuries；
4. Lower limb muscle weakness
5. Unable to cooperate with VAS pain assessment
6. Contraindications for nerve block include infection at the puncture site.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Control Group (Group R); Ultrasound-guided single-shot adductor canal block (ACB) with 20 mL of 0.5% ropivacaine	Drug: Ropivacaine; Ultrasound-guided single-shot adductor canal block (ACB) with 20 mL of 0.5% ropivacaine
Experimental: Experimental Group (Group RH); Ultrasound-guided single-shot ACB with a 20 mL mixture of 0.5% ropivacaine and 0.5 mg hydromorphone	Drug: Ropivacaine + Hydromorphone; Ultrasound-guided single-shot ACB with a 20 mL mixture of 0.5% ropivacaine and 0.5 mg hydromorphone

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
VAS score	The co-primary outcomes were the resting and movement (active, 45° knee flexion) VAS scores (0-10) at 4, 8, 12, and 24 h after surgery, each referenced to a pre-operative baseline score.	Preoperatively and at 4, 8, 12, and 24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quadriceps strength	Secondary outcomes were quadriceps strength (Lovett scale, 0-5) before surgery and at 4, 8, 12, and 24 hours after surgery.	Preoperatively and at 4, 8, 12, and 24 hours postoperatively
Postoperative analgesia-related adverse reactions		At 4, 8, 12, and 24 hours postoperatively
Postoperative opioid use		At 4, 8, 12, and 24 hours postoperatively

Collaborators and Investigators

• Sponsor: China-Japan Friendship Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 10, 2026
• Primary Completion (Actual): June 10, 2026
• Study Completion (Actual): June 13, 2026

Study Registration Dates

• First Submitted: July 20, 2026
• First Submitted That Met QC Criteria: July 20, 2026
• First Posted (Actual): July 23, 2026

Study Record Updates

• Last Update Posted (Actual): July 23, 2026
• Last Update Submitted That Met QC Criteria: July 20, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Total knee arthroplasty; Ropivacaine; Postoperative analgesia; Hydromorphone; Adductor canal block; Multimodal Analgesia
• Additional Relevant MeSH Terms: Organic Chemicals; Heterocyclic Compounds; Heterocyclic Compounds, Fused-Ring; Alkaloids; Polycyclic Aromatic Hydrocarbons; Polycyclic Compounds; Anilides; Amides; Aniline Compounds; Amines; Heterocyclic Compounds, 4 or More Rings; Morphinans; Opiate Alkaloids; Heterocyclic Compounds, Bridged-Ring; Phenanthrenes; Morphine Derivatives; Ropivacaine; Hydromorphone
• Other Study ID Numbers: CXPJJH123001-2326 (Other Grant/Funding Number: Hubei Chen Xiaoping Science and Technology Development Foundation)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No