Migration Rate for Continuous Adductor Canal Block Catheters After Primary Total Knee Arthroplasty Surgery: a Comparison Between Two Insertion Techniques

NCT07681622 | Not Yet Recruiting

• 1 other identifier: MSH REB # 1424
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

Continuous adductor canal block (CACB) is becoming increasingly popular for providing postoperative analgesia following knee arthroplasties. These continuous blocks are provided through inserted nerve catheters and effectively extend the duration of analgesia, thereby reducing opioid consumption. This, in turn, helps minimize opioid-related side effects, promotes early ambulation, and supports earlier discharge. However, catheter migration remains a significant concern, as the catheter tip can become displaced from the adductor canal due to movements associated with ambulation or physiotherapy. In this study, the investigators compare the migration rates of two different techniques for CACB catheters insertion: the Interfascial plane between SArtorious muscle and FEmoral artery (ISAFE) and the Out Of Plane parallel to Saphenous nerve (OOPS) techniques. Pain scores and opioid consumption on postoperative day 1 (POD1) will also be assessed as secondary outcomes. The hypothesis is that both techniques will result in similar migration rates of CACB catheter.

Conditions

Arthroplasty Replacement, Knee; Anesthesia Conduction

Outcome Measures

Primary Outcomes (1)

• Catheter migration

  Rate of migration of the catheter tip to outside the adductor canal , verified by ultrasound assessment

  24 hours

Secondary Outcomes (5)

• Pain intensity

  24 hours

• Opioid consumption

  24 hours

• Number of attempts for catheter insertion

  4 hours

• Potential complications related to CACB

  24 hours

• Incidence of sensory block

  24 hours

Study Arms (2)

ISAFE technique

ACTIVE COMPARATOR

Adductor canal block catheter inserted perpendicular to the saphenous nerve , catheter tip located in the fascial plane between sartorius muscle and femoral artery

Procedure: ISAFE technique for adductor canal catheter insertion

OOPS technique

EXPERIMENTAL

Adductor canal block catheter inserted parallel to the saphenous nerve , catheter tip located lateral to the femoral artery

Procedure: OOPS technique

Interventions

ISAFE technique for adductor canal catheter insertion PROCEDURE

Adductor canal block catheter inserted perpendicular to the saphenous nerve , catheter tip located in the fascial plane between sartorius muscle and femoral artery

ISAFE technique

OOPS technique PROCEDURE

Adductor canal block catheter inserted perpendicular to the saphenous nerve , catheter tip located in the fascial plane between sartorius muscle and femoral artery

OOPS technique

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Non-pregnant patients older than 18 years of age;
• Patients undergoing unilateral primary total knee arthroplasty in an inpatient regime;
• American Society of Anesthesiologist (ASA) physical status Class I - IV patients;
• With sufficient understanding and co-operation about usage of a perineural catheter for pain management;
• With body mass index (BMI) under 45;
• With no history of strong opioid use of more than 30 mg of oral morphine equivalent (OME)/day during the 2 weeks preceding the surgery;
• No alcohol or drug use disorder history;
• With no contra-indication for the performance of ACB and IPACK block;
• With no contra-indication for spinal anesthesia;
• With no contra-indication for CACB catheter insertion (local site infection, systemic infection, anatomical abnormality);
• With no contra-indication for the medications to be used accordingly with the study protocol (ropivacaine, lidocaine, mepivacaine, midazolam, fentanyl, propofol, cefazolin, tranexamic acid, dexamethasone, ondansetron, celecoxib, acetaminophen, hydromorphone);
• Speak and understand the English language;
• Agree to participate on this study through the signature of the consent form.

You may not qualify if:

• They have a failed spinal anesthesia and needs for a conversion to general anesthesia;
• The peripheral nerve blocks are not possible to be performed due to technical difficulties;
• A deviation of the protocol occurs (not follow the standardized postoperative analgesia orders; need an emergency re-operation of the same knee, in less than 24 hours, due to a surgical complication; have an important perioperative complication, leading to abnormal level of conscience);
• CACB catheter has issues on its function and needs to be removed before the migration assessment
• Patient decides to withdraw from the study.

Sponsors & Collaborators

• University of Toronto: lead

Study Sites (1)

Mount Sinai Hospital

Toronto, Ontario, M5G 1X5, Canada

Location

Related Publications (12)

• Hanson NA, Allen CJ, Hostetter LS, Nagy R, Derby RE, Slee AE, Arslan A, Auyong DB. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg. 2014 Jun;118(6):1370-7. doi: 10.1213/ANE.0000000000000197.

  PMID: 24842182 BACKGROUND

• Warman P, Nicholls B. Ultrasound-guided nerve blocks: efficacy and safety. Best Pract Res Clin Anaesthesiol. 2009 Sep;23(3):313-26. doi: 10.1016/j.bpa.2009.02.004.

  PMID: 19862890 BACKGROUND

• Jeng CL, Torrillo TM, Rosenblatt MA. Complications of peripheral nerve blocks. Br J Anaesth. 2010 Dec;105 Suppl 1:i97-107. doi: 10.1093/bja/aeq273.

  PMID: 21148659 BACKGROUND

• Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):3-10. doi: 10.1097/AAP.0000000000000169.

  PMID: 25376972 BACKGROUND

• Jaeger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med. 2013 Nov-Dec;38(6):526-32. doi: 10.1097/AAP.0000000000000015.

  PMID: 24121608 BACKGROUND

• Soffin EM, Gibbons MM, Ko CY, Kates SL, Wick EC, Cannesson M, Scott MJ, Wu CL. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Total Hip Arthroplasty. Anesth Analg. 2019 Mar;128(3):454-465. doi: 10.1213/ANE.0000000000003663.

  PMID: 30044289 BACKGROUND

• Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions. Am Fam Physician. 2009 Dec 15;80(12):1371-8.

  PMID: 20000300 BACKGROUND

• Schug SA, Zech D, Grond S. Adverse effects of systemic opioid analgesics. Drug Saf. 1992 May-Jun;7(3):200-13. doi: 10.2165/00002018-199207030-00005.

  PMID: 1354445 BACKGROUND

• Buvanendran A, Fiala J, Patel KA, Golden AD, Moric M, Kroin JS. The Incidence and Severity of Postoperative Pain following Inpatient Surgery. Pain Med. 2015 Dec;16(12):2277-83. doi: 10.1111/pme.12751. Epub 2015 Apr 27.

  PMID: 25917518 BACKGROUND

• Dos Santos Fernandes H, Siddiqui N, Peacock S, Vidal E, Wolfstadt J, Gleicher Y. Inter-fascial space between SArtorius muscle and FEmoral artery (ISAFE): A suggested approach for Adductor Canal catheter placement. J Clin Anesth. 2022 Feb;76:110571. doi: 10.1016/j.jclinane.2021.110571. Epub 2021 Nov 8. No abstract available.

  PMID: 34763273 BACKGROUND

• Gleicher Y, Dos Santos Fernandes H, Peacock S, Alekberli T, Di Grazia V, Estrellas R, Wolfstadt J, Matelski J, Siddiqui N. Comparison of migration rates between traditional and tunneled adductor canal block catheters: a randomized controlled trial. Reg Anesth Pain Med. 2024 Jun 3;49(6):423-428. doi: 10.1136/rapm-2023-104654.

  PMID: 37704437 RESULT

• Fujino T, Yoshida T, Kawagoe I, Hinotsume A, Hiratsuka T, Nakamoto T. Migration rate of proximal adductor canal block catheters placed parallel versus perpendicular to the nerve after total knee arthroplasty: a randomized controlled study. Reg Anesth Pain Med. 2023 Aug;48(8):420-424. doi: 10.1136/rapm-2022-104303. Epub 2023 Mar 28.

  PMID: 36977526 RESULT

Study Officials

• Hermann dos Santos Fernandes, MD, PhD

  University of Toronto

  STUDY CHAIR

Central Study Contacts

Divya Mahajan, MD

CONTACT

+14374396016; divya.mahajan@sinaihealth.ca

Yehoshua Gleicher

CONTACT

+14168754533; josh.gleicher@sinaihealth.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dr

Study Record Dates

• First Submitted: June 19, 2026
• First Posted: July 2, 2026
• Study Start: June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2027
• Last Updated: July 2, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, CSR
• Time Frame: At the conclusion of the study

Locations

CA (1)