ISRCTN ISRCTN60611146
DOI https://doi.org/10.1186/ISRCTN60611146
EudraCT/CTIS number 2013-002439-10
ClinicalTrials.gov number NCT01560767
Secondary identifying numbers 15232
Submission date
08/11/2013
Registration date
08/11/2013
Last edited
13/08/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
The aim of this study is to find out if there is a difference in pain prior to physiotherapy on the first day after the operation between patients who are given local knee injections following a total knee replacement, compared to the standard treatment (femoral nerve block). Another aim of this study is to assess the function and health outcome of the study group at 6 weeks after the operation.

Who can participate?
All patients undergoing a total knee replacement surgery under the care of an orthopaedic consultant at the University Hospitals Coventry and Warwickshire NHS Trust, UK.

What does the study involve?
Patients will be randomly allocated to receive either local knee injections or standard treatment. On the first and second day after the operation, participants will be asked to rate their pain in and around their knee before and after physiotherapy. In addition, patients will be followed up at 6-8 weeks after the operation.

What are the possible benefits and risks of participating?
There are no specific advantages to you taking part in the study. However, the information we get from this study may help up to choose the best type of pain relief for patients having the same sort of surgery as you in the future.

Where is the study run from?
Warwick Orthopaedics, University of Warwick, UK.

When is the study starting and how long is it expected to run for?
The study will begin recruiting in December 2013 for 24 months.

Who is funding the study?
The study is being funded by the National Institute for Health Research (NIHR) (UK).

Who is the main contact?
Mr Peter Wall
P.D.H.Wall@warwick.ac.uk

Contact information

Mr Peter Wall
Scientific

Warwick Clinical Trials Unit
Clinical Sciences Research Laboratories
University Hospital Coventry and Warwickshire
Coventry
CV2 2DX
United Kingdom

ORCiD logoORCID ID 0000-0003-3149-3373
Email P.D.H.Wall@warwick.ac.uk

Study information

Study designRandomised; Interventional; Design type: Not specified, Treatment
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details of C.A.Lawrence below to request a patient information sheet
Scientific titlePerioperative Analgesia for Knee Arthroplasty: a prospective randomised controlled trial
Study acronymPAKA
Study objectivesArthritis of the knee is a common problem; it causes inability to walk without pain and a reduction in activity levels. Total knee replacements are performed for relief of this debilitating pain and are the most common form of joint replacement performed within the NHS. Increased demand for total knee replacement, together with an ageing population, has led to an annual increase in frequency of this form of replacement. The operation involves removing worn-out surfaces and replacing them with implants.

Knee replacement generates substantial amounts of postoperative pain, which affects range of movement and ability to mobilise. It is important that good pain relief is administered post-operatively to enhance patient rehabilitation. Current pain relief targets large groups of nerves, paralysing areas of the body of limb. Recently, the use of injections around the knee has gained in popularity. These injections have the advantage of delivering drugs directly to the sources of pain, thereby avoiding side effects in the rest of the body. They contain different analgesics, such as local anaesthetics, opiates and non-steriodal anti-inflammatory drugs. Some of the theorectical advantages include reduced requirements for painkillers after the operation, and earlier mobilisation, discharge and better overall outcome following knee surgery.

We propose to perform a single-centre patient-based randomised controlled trial of local knee injections (peri-articular infiltration) versus standard treatment (femoral nerve block) with pain as the primary outcome measure. In preparation for this study we have performed a pilot study recruiting 46 patients which has supplied us with the data required to plan this full trial.
Ethics approval(s)13/WM/0316; First MREC approval date 23/09/2013
Health condition(s) or problem(s) studiedTopic: Musculoskeletal; Subtopic: Musculoskeletal (all Subtopics); Disease: Musculoskeletal
InterventionFemoral Nerve Block, Standard femoral nerve block; Periarticular infiltration, A multi-modal peri-articular knee infiltration; Follow Up Length: 2 month(s); Study Entry: Single Randomisation only

Randomisation will be stratified between general anaesthetic and spinal block.

Data will be collected at the follow time points: baseline, day 1 and day 2 post-operation, 6 weeks post operation
Intervention typeProcedure/Surgery
Primary outcome measureVisual Analogue Scale; Timepoint(s): Pre-physiotherapy on the first post-operative day
Secondary outcome measures1. As required analgesia; timepoint(s): the total use of as required analgesia in the first 48 hours after the operation
2. Bed transfers; timepoint(s): day 1 and 2 postoperatively
3. Distance mobilised; timepoint(s): day 1 and 2 postoperatively
4. EQ-5D-5L; timepoint(s): baseline and 6 weeks postoperatively
5. Knee range of movement; timepoint(s): day 1 and 2 postoperatively
6. Ordinal Pain Score; timepoint(s): routinely collected by nursing staff every 6 hours for the first 48 hours following surgery
7. Oxford Knee Score; timepoint(s): baseline and 6 weeks postoperatively
8. Routine physio assessments
9. Bed transfers and distance mobilised
9. Straight leg raise; timepoint(s): day 1 and 2 postoperatively
10. Timed up and go; timepoint(s): day 1 and 2 postoperatively
Overall study start date30/09/2013
Completion date31/10/2015

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participantsPlanned Sample Size: 264; UK Sample Size: 264
Key inclusion criteriaAll patients undergoing an elective primary unilateral total knee arthroplasty under the care of an orthopaedic consultant at University Hospitals Coventry and Warwickshire NHS Trust.
Target Gender: Male & Female ; Lower Age Limit 18 years
Key exclusion criteria1. A concomitant medical or psychiatric problem which, in the opinion of the Investigator, would prevent completion of treatment or follow-up
2. Patients with a preoperative history of neurological abnormality in the ipsilateral leg
3. Patients with specific contraindication to the analgesic agents used
4. Participation in a clinical trial of an investigational medicinal product in the last 90 days
5. Previous entry in the present trial
Date of first enrolment01/12/2013
Date of final enrolment31/10/2015

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

University Hospitals Coventry & Warwickshire NHS Trust
Coventry
CV2 2DX
United Kingdom

Sponsor information

University Hospitals Coventry & Warwickshire NHS Trust (UK)
Hospital/treatment centre

Clinical Sciences Research Unit
Clinical Sciences Building
Clifford Bridge Road
Coventry
CV2 2DX
England
United Kingdom

ROR logo "ROR" https://ror.org/025n38288

Funders

Funder type

Government

National Institute for Health Research Central Commissioning Facility; Grant Codes: PB-PG-0212-27098

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryData sharing statement to be made available at a later date
Publication and dissemination planNot provided at time of registration
IPD sharing planThe data sharing plans for the current study are unknown and will be made available at a later date

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 21/12/2015 Yes No
Results article results 01/07/2017 Yes No
HRA research summary 28/06/2023 No No

Editorial Notes

13/08/2019: ClinicalTrials.gov number added.
18/12/2018: The following changes were made to the trial record:
1. Publication reference added.
2. IPD sharing statement added.
3. Contact details updated.
22/12/2015: Publication reference added.