Adductor Canal Block (ACB) Versus ACB /Saphenous Block in Patients Undergoing Anterior Cruciate Ligament Repair

Cairo University (CU)

Status: Unknown

Conditions: Postoperative Pain

Treatments: Procedure: Ultrasound Guided Adductor Canal Block; Procedure: Ultrasound Guided Saphenous Nerve Block; Drug: Bupivacaine 10ml; Drug: Bupivacaine 20 ml; Drug: Bupivacaine 30ml; Procedure: General anesthesia

Study type: Interventional

Funder types: Other

Identifiers

NCT04443634

N-27-2017

Details and patient eligibility

About

Knee surgeries are associated with severe postoperative pain. Blocking the femoral nerve (or saphenous nerve) in the adductor canal is increasingly used for knee analgesia. It carries potential benefits that encourage anesthesiologists to do it. It has a motor sparing property. Injection of local anesthetics in this lengthy canal that contains a variable amount of connective or fibrous tissue might lead to a patchy distribution of local anesthetics. Thus, the possibility of incomplete block of the saphenous nerve (most important nerve in knee innervations) cannot be excluded.

Full description

Aim of the study is to compare the efficacy of the adductor canal block to the combined adductor canal block and saphenous nerve block at the distal third of thigh in the intermuscular plane between Vastus Medialis and Sartorius muscles in pain relief following knee arthroscopic anterior cruciate ligament repair.

After written informed consent, patients will be randomized in three groups:

Group (Adductor 20): Ultrasound guided adductor canal block will be performed with injection of 20 ml bupivcaine 0.5%.

Group (Adductor 30) Ultrasound guided adductor canal block will be performed with injection of 30 ml bupivacaine 0.5%. Group (Adductor/saphenous ): Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine 0.5%, combined with ultrasound guided saphenous

Enrollment: 88 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Scheduled for knee orthopedic ( ACL repair)
• Physical status ASA I, II.
• Body mass index (BMI): > 20 kg/m2 and < 35 kg/m2.

Exclusion criteria

• • Patients with known sensitivity or contraindication to drug used in the study (local anesthetics, opioids).

  • History of psychological disorders and/or chronic pain.
  • Contraindication to regional anesthesia e.g. local sepsis, pre- existing peripheral neuropathies and coagulopathy.
  • Infection of the skin at the site of needle puncture area.
  • Patient refusal.
  • Severe respiratory or cardiac disorders.
  • Advanced liver or kidney disease.
  • Pregnancy.
  • Patient with surgery duration more than two hours.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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88 participants in 3 patient groups

Adductor 20

Experimental group

Description:

Ultrasound guided adductor canal block will be performed with injection of 20 ml bupivacaine

Treatment:

Procedure: Ultrasound Guided Adductor Canal Block

Drug: Bupivacaine 20 ml

Procedure: General anesthesia

Adductor 30

Experimental group

Description:

Ultrasound guided adductor canal block will be performed with injection of 30ml bupivacaine

Treatment:

Procedure: Ultrasound Guided Adductor Canal Block

Procedure: General anesthesia

Drug: Bupivacaine 30ml

Adductor /Saphenous

Experimental group

Description:

Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine , combined with ultrasound guided saphenous nerve block at the distal third of the thigh in the intermuscular plane between Vastus Medialis and Sartorius muscle with injection of 10ml bupivacaine 0.5%.

Treatment:

Procedure: Ultrasound Guided Adductor Canal Block

Procedure: Ultrasound Guided Saphenous Nerve Block

Drug: Bupivacaine 20 ml

Drug: Bupivacaine 10ml

Procedure: General anesthesia