Single-shot Adductor Canal Block With Levobupivacaine and Dexmedetomidine in Total Knee Arthroplasty

Assiut University

Status and phase: Completed; Phase 3; Phase 2

Conditions: Levobupivacaine; Dexmedetomidine; Adductor Canal Block

Treatments: Drug: Levobupivacaine; Drug: Dexmedetomidine Hydrochloride

Study type: Interventional

Funder types: Other

Identifiers

NCT04968392

17300626

Details and patient eligibility

About

Total knee arthroplasty surgery is associated with severe postoperative pain and adequate pain management is necessary for early postoperative mobilization and rehabilitation. Although good postoperative pain control may be achieved by continuous epidural anesthesia or femoral nerve block, both methods have adverse effects such as muscle weakness, which may delay postoperative mobilization.

Full description

The adductor canal block (ACB) is a relatively new block providing analgesia for knee surgery, which not only blocks the largest sensory branch of the femoral nerve but also results in less reduction of quadriceps muscle strength, compared with the femoral nerve block (FNB) in adult patients.

Randomized controlled trials have revealed that ACB provides at least equal analgesia as FNB, preserves quadriceps muscle strength better than FNB, and thus allowing for functional recovery within the first 24-hour post-TKA. However, one important limitation of single-shot peripheral nerve block is the short duration of analgesia. Because the average duration of severe pain after TKA takes 2-3 days, a continuous ACB via catheter would seem to be a good choice. Unfortunately, perineural catheters may be technically difficult to insert, are prone to premature dislodgement, and may increase infection risk. There also were some case reports of local anesthetic-induced myotoxicity after continuous ACB.

Enrollment: 60 patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ASA physical status I or II
• undergoing elective primary total knee arthroplasty surgery under spinal anesthesia.

Exclusion criteria

• Patients with a known history of significant hepatic,
• renal, heart disease, autoimmune disease,
• any known convulsive disorder, any psychiatric disorders, chronic pain,
• pregnant females, regular use analgesics, anti-depressants, or opioids in the previous 2 months, revision surgery, morbid obesity, allergy to local anesthetics or morphine

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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60 participants in 2 patient groups

L group

Experimental group

Description:

20 mL of 0.25% levobupivacaine plus 1 mL normal saline

Treatment:

Drug: Levobupivacaine

LD group

Experimental group

Description:

20 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine

Treatment:

Drug: Dexmedetomidine Hydrochloride