Single Shot Versus Continuous Adductor Canal Block in Patients Undergoing Total Knee Arthroplasty

Aswan University Hospital

Status: Completed

Conditions: Rheumatism Knee

Treatments: Procedure: single-shot adductor canal block

Study type: Interventional

Funder types: Other

Identifiers

NCT04986878

24-10-15

Details and patient eligibility

About

Adductor canal block (ACB) has emerged as an option for postoperative regional analgesia in patients undergoing total knee arthroplasty (TKA).

Full description

Various approaches to the performance of peripheral nerve blocks for postoperative pain control in patients undergoing TKA have been described in the literature. These approaches include lumbar plexus block, femoral nerve block (FNB), with or without a sciatic nerve block, and most recently the ACB. FNB is a commonly used modality for postoperative analgesia after TKA. It is considered by some as the gold standard or the cornerstone of postoperative analgesia after TKA. However, FNB reduces quadriceps muscle strength essential for mobilization and active contribution in any physical rehabilitation program. Quadriceps weakness places the patients at risk of falling. which may be detrimental to postoperative recovery. The ACB has recently emerged as an appealing alternative to FNB as it is predominately a sensory nerve block of a more distal branch of the femoral nerve ( the saphenous nerve).

Enrollment: 60 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients scheduled for primary total knee arthroplasty with
• American Society of Anesthesiologists (ASA) physical status I -III,
• mentally competent and able to give consent for enrollment in the study.

Exclusion criteria

1. Patient younger than 18 years old or older than 70 years old
2. Allergy to local anesthetics, systemic opioids (fentanyl, morphine, hydromorphone, and any of the drugs included in the multimodal perioperative pain protocol.
3. Revision surgeries were excluded.
4. Impaired kidney functions and patients with coagulopathy were also excluded.
5. Chronic pain syndromes and patients with chronic opioid use defined as the use of regular daily doses of systemic narcotics for the past 6 months prior to the surgery.
6. BMI of 40 or more
7. Pregnancy (positive urine pregnancy test result in Preop area on the morning of surgery)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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60 participants in 2 patient groups

Single shot adductor canal block

Active Comparator group

Description:

Following sterile preparation and draping, an ultrasound survey of the medial thigh was performed, halfway between the superior anterior iliac spine and the patella. The superficial femoral artery has been identified beneath the sartorius muscle in a short-axis view, with the vein just inferior and the saphenous nerve just lateral to the artery. A 20 Gauge, 120 mm, non-cuttings tip echogenic needle (SonoPlex STIM, Germany) needle was introduced in-plane, and 2 to 3 mL of LA bolus (0.25 % Bupivacaine) was used to confirm proper needle placement in the adductor canal near the saphenous nerve. Then, a bolus of 20 ml of Bupivacaine 0.25 % was injected through the needle

Treatment:

Procedure: single-shot adductor canal block

Continuous adductor canal block

Active Comparator group

Description:

a catheter was secured in place using Tegaderm. The catheters were connected to a pump that infused local anesthetic, 20 mL of 0.25 % bupivacaine, followed by 48 hours of continuous infusion of 0.125 % bupivacaine at 5 mL/h.

Treatment:

Procedure: single-shot adductor canal block