- ICH GCP
- Registro degli studi clinici negli Stati Uniti
- Sperimentazione clinica NCT01991288
Analgesic Efficacy of Saphenous Nerve Block in Total Knee Replacement
Does Saphenous Nerve Block Improve Analgesia After Total Knee Replacement When Used in Combination With Local Infiltration Analgesia? A Prospective Randomised Double Blinded Trial.
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Descrizione dettagliata
Introduction:
Local infiltration analgesia (LIA) is considered acceptable after total knee replacements (TKR) in terms of analgesia, ease of performance, early mobilization and early hospital discharge . Continuous femoral nerve block has been used to enhance post op pain relief (POPR) for TKR but at the expense of motor blockade . A Sub sartorial approach to saphenous nerve block (SNB) spares the motor block . To date the role of saphenous nerve block for POPR in TKR has not been evaluated.
Methodology:
In order to test this hypothesis, we proposed to carry out a prospective randomized controlled double blinded (surgeon and assessor) trial study. With institutional ethics approval and having obtained written informed consent from each patient, 20 ASA 1 - 3 patients scheduled to undergo TKR under spinal anesthesia +/- sedation were allocated to one of two groups i.e. Group (SNB): patients receiving SNB sub sartorial approach and Group (NSNB): patients not receiving SNB.
Group allocation was determined using computer generated random number tables. Sealed envelopes were opened on the day of the surgery by the attending anesthetist responsible for the care of the recruited patient.
Postoperative period:
Patients were then assessed for pain at rest and on movement on arrival in recovery and then at 6 , 12 and 24 hrs. Visual analogue scale on a 10 cm straight line was used to assess postoperative pain scores as predictive value of post operative analgesia on rest and movement i.e passive flexion of knee to 30 degree . Patients were assessed for any motor block by using maximum tolerable range of active knee flexion (MKF) and maximum range of straight leg raise(MSLR) on arrival in recovery and at 6, 12 and 24 hrs. All patients received regular paracetamol 1g 6 hourly, diclofenac 75 mg 12 hourly, oxycontin 10-20 mg ( depending on age) 12 hourly and oxynorm 10 mg as rescue analgesia.
Tipo di studio
Iscrizione (Effettivo)
Fase
- Fase 4
Contatti e Sedi
Luoghi di studio
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Cork, Irlanda, 0000
- Dept. of Anaesthesia & Intensive Care Unit, Cork University Hospital
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
American Society of Anaesthesia (ASA) Grade I-lll patients Undergoing elective Total Knee Arthroplasty Patients able to consent and understand all the components of the study.
Exclusion Criteria:
Demented patients Patients having bilateral Knee Replacements Patients unable to comprehend the use of pain scales Allergy to any of the medications used in the study Renal dysfunction Coagulation disorders Peptic ulcer disease precluding use of non-steroidal anti-inflammatory drugs (NSAIDs) Patients unable to use regular opioid medication Any chronic pain condition other than osteoarthritis of the knee.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Doppio
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
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Sperimentale: SNB Saphenous Nerve block
Patients received SNB preoperatively at mid thigh level with ultrasound guidance.
10 mls 0.5% bupivacaine was administered for nerve block by the anesthetist.
All patients also received peri operative Local Infiltration Analgesia by the surgeon.
All patients will receive preoperative oxycontin, peri operative paracetamol and diclofenac.
Post operatively all patients received regular paracetamol 1g 6 hourly, Diclofenac sodium 12 hourly and oxycontin 10-20 mg 12 hourly.
All patients received standardized spinal block by the same anesthetist, post nerve block for surgery.
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Patients in group SNB received an ultrasound guided SNB (a sub sartorial approach) by a single operator with 10 mls 0.5% bupivacaine.
At the end of surgery periarticular knee infiltration of 30 mls 0.5% levobupivacaine + 70 mls 0.9% saline + 0.5 mg adrenaline was performed in a staged fashion by the surgeon, beginning with infiltration of the deep structures on tibial surface at 1mm depth around all exposed tissues, medial and lateral collateral ligament origin, all cut surfaces of extensor mechanism, all cut surface of skin and subcutaneous tissue
Altri nomi:
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Comparatore attivo: NSNB Non Saphenous Nerve Block
Patients only received Local Infiltration Analgesia.
As per protocol all patients received the same pre, peri and post operative analgesia as described in the experimental group.
All patients had a standardized spinal block for surgery.
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All patients at the end of surgery received periarticular knee infiltration of 30 mls 0.5% levobupivacaine + 70 mls 0.9% saline + 0.5 mg adrenaline, in a staged fashion by the surgeon, beginning with infiltration of the deep structures on tibial surface at 1mm depth around all exposed tissues, medial and lateral collateral ligament origin, all cut surfaces of extensor mechanism, all cut surface of skin and subcutaneous tissue
Altri nomi:
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Lasso di tempo |
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Pain on movement at 24 hours time point post operatively
Lasso di tempo: 24 hours hours time point
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24 hours hours time point
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Misure di risultato secondarie
Misura del risultato |
Lasso di tempo |
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pain on movement at 6 and 12 hour time point
Lasso di tempo: 6 and 12 hours time points
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6 and 12 hours time points
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pain at rest at 6, 12 and 24 hours time points
Lasso di tempo: 6, 12 and 24 hours time points
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6, 12 and 24 hours time points
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Maximum Knee Flexion at 6, 12 and 24 hours time points
Lasso di tempo: 6, 12 and 24 hours time points
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6, 12 and 24 hours time points
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Maximum Straight Leg Raise Test at 6, 12 and 24 hours time points
Lasso di tempo: 6, 12 and 24 hours time points
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6, 12 and 24 hours time points
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Time to First request for rescue analgesia
Lasso di tempo: 24 hours
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24 hours
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Cumulative Opioid consumption in 24 hours
Lasso di tempo: 24 hours
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24 hours
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Cumulative opioid consumption till discharge
Lasso di tempo: till discharge time
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till discharge time
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6 Minute walk test
Lasso di tempo: At 24 hours Post block Conduction
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At 24 hours Post block Conduction
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Altre misure di risultato
Misura del risultato |
Lasso di tempo |
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Time to discharge from hospital
Lasso di tempo: 1 week
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1 week
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Collaboratori e investigatori
Sponsor
Investigatori
- Direttore dello studio: George Shorten, FFARCSI, PhD, Dept. of Anaesthesia & ICU, Cork University Hospital, Cork, Ireland
Studiare le date dei record
Studia le date principali
Inizio studio
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Stima)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Processi patologici
- Complicanze postoperatorie
- Dolore
- Manifestazioni neurologiche
- Dolore, Postoperatorio
- Effetti fisiologici delle droghe
- Agenti adrenergici
- Agenti neurotrasmettitori
- Meccanismi molecolari dell'azione farmacologica
- Depressori del sistema nervoso centrale
- Agenti autonomi
- Agenti del sistema nervoso periferico
- Agenti del sistema sensoriale
- Anestetici
- Alfa-agonisti adrenergici
- Agonisti adrenergici
- Anestetici, Locali
- Agenti broncodilatatori
- Agenti antiasmatici
- Agenti del sistema respiratorio
- Beta-agonisti adrenergici
- Simpaticomimetici
- Agenti vasocostrittori
- Midriatici
- Bupivacaina
- Levobupivacaina
- Epinefrina
- Racepinefrina
- Borato di adrenalina
Altri numeri di identificazione dello studio
- JR-0786-GI
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .
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