Comparing Pain Control and Urinary Retention After Revision Knee Replacement Surgery Using Spinal Anesthesia With or Without Intrathecal Morphine

What this Trial Is About

Researchers are investigating pain management options for patients undergoing revision total knee arthroplasty rTKA, a common and often painful surgery. The study compares spinal anesthesia with intrathecal morphine IM to spinal anesthesia without IM, focusing on the risk of postoperative urinary retention POUR and pain control. This research is important because IM can reduce pain but may cause urinary retention, which increases infection risks, and there is limited evidence specifically for rTKA cases. Participants will be randomly assigned to one of two groups one receiving spinal anesthesia with IM plus single shot and continuous adductor canal blocks CACB and IPACK block, and the other receiving the same nerve blocks and spinal anesthesia but without IM. Both groups receive comprehensive nerve blocks and standard medications during surgery, with catheter placement for continuous nerve block infusion lasting 48-60 hours. The study is designed as a randomized, blinded trial to compare outcomes between these approaches. During the study, patients will be monitored closely for urinary retention and pain levels for 48 hours after spinal anesthesia. Assessments include pain at rest and movement, opioid use, and quality of recovery. Patients may be discharged with the nerve block catheter in place, with instructions for home care and follow-up phone assessments. The study aims to measure if avoiding IM can reduce urinary retention without worsening pain control, with all participants receiving detailed perioperative care and monitoring throughout the study period.

Post-Operative Urinary Retention on Revision Knee Arthroplasty: the Role of Intrathecal Morphine