Ultrasound-Guided PASC Block vs Femoral-Sciatic Nerve Block for Postoperative Analgesia After Total Knee Arthroplasty

Ain Shams University

Status: Completed

Conditions: Postoperative Pain; Knee Osteoarthritis; Total Knee Arthroplasty

Treatments: Procedure: Ultrasound-Guided Para-sartorial Compartments Block; Procedure: Ultrasound-Guided Femoral Nerve Block plus Sciatic Nerve Block

Study type: Interventional

Funder types: Other

Identifiers

NCT07320833

FMASU MD 29/2023

Details and patient eligibility

About

This randomized, double-blind comparative study evaluates postoperative analgesic efficacy and motor effects of ultrasound-guided para-sartorial compartments (PASC) block versus ultrasound-guided combined femoral-sciatic nerve block in patients undergoing total knee arthroplasty. The primary endpoint is total nalbuphine rescue analgesia consumption in the first 24 postoperative hours. Secondary endpoints include pain scores (NRS), motor function using a modified Bromage scale, block performance characteristics, and complications.

Enrollment: 62 patients

Sex: All

Ages: 60 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 60 to 70 years
• Scheduled for elective total knee arthroplasty under general anesthesia
• American Society of Anesthesiologists physical status class I or II
• Provided written informed consent

Exclusion criteria

• American Society of Anesthesiologists physical status class III or IV
• Pre-existing neurological abnormality of the lower extremity
• Infection near the planned block site
• History of psychiatric illness
• History of drug abuse
• Known allergy to local anesthetics or any study medications (bupivacaine, acetaminophen, ketorolac, nalbuphine)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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62 participants in 2 patient groups

Femoral Nerve Block plus Sciatic Nerve Block

Active Comparator group

Description:

After induction of general anesthesia, participants receive an ultrasound-guided single-shot femoral nerve block with 15 milliliters of 0.25% bupivacaine and an ultrasound-guided single-shot popliteal sciatic nerve block with 15 milliliters of 0.25% bupivacaine. Postoperative multimodal analgesia includes intravenous acetaminophen and ketorolac. Rescue analgesia is intravenous nalbuphine 5 milligrams when the Numeric Rating Scale pain score is 3 or higher, up to 20 milligrams per day.

Treatment:

Procedure: Ultrasound-Guided Femoral Nerve Block plus Sciatic Nerve Block

Para-sartorial Compartments Block

Experimental group

Description:

After induction of general anesthesia, participants receive an ultrasound-guided single-shot para-sartorial compartments block using a single needle entry point with three injections of 0.25% bupivacaine: 10 milliliters inside the femoral triangle with periarterial and subsartorial spread, 10 milliliters in the subsartorial plane at the apex of the femoral triangle between sartorius and vastus medialis muscles, and 10 milliliters in the suprasartorial compartment at the level of the intermediate femoral cutaneous nerve (total 30 milliliters). Postoperative multimodal analgesia includes intravenous acetaminophen and ketorolac. Rescue analgesia is intravenous nalbuphine 5 milligrams when the Numeric Rating Scale pain score is 3 or higher, up to 20 milligrams per day.

Treatment:

Procedure: Ultrasound-Guided Para-sartorial Compartments Block