Depomedrol for Genicular Nerve Block.
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      This study is designed to test the efficacy of adding Depomedrol a long-acting steroid to
      bupivacaine for relieving postoperative pain and reducing opioid requirements following total
      knee replacement surgery. For this purpose, Depomedrol will be added to bupivacaine for
      ultrasound-guided Genicular nerve block combined with spinal anesthesia.
    

Detailed description: 
      TKA remains a challenge for physicians as more than half of these patients experience extreme
      knee pain immediately after surgery. The management of pain in patients undergoing total knee
      arthroplasty (TKA) remains a challenge for the anesthesiologist even with regional anesthesia
      as no single regional technique is adequate to balance effective analgesia with minimal
      muscle weakness. Severe postoperative pain following TKA has been shown to negatively affect
      early mobilization, physical rehabilitation, time to discharge, and overall post-op recovery.
      Multimodal analgesia incorporating regional anesthesia techniques provides optimum analgesia
      and minimizes the use of opioids and their side effects. Proximal nerve blocks such as the
      lumbar plexus, femoral nerve, and proximal sciatic nerve blocks provide excellent analgesia
      but frequently cause motor weakness, which reduces the patient's mobility. A distal blockade
      of genicular branches has also been described using ultrasound in acute and chronic pain
      management with fewer side effects. The superior medial genicular nerve and lateral genicular
      nerve can be identified using ultrasound and blocked at the level of the medial
      intramuscular, and lateral femoral epicondyles deep to the vastus medialis and lateralis,
      respectively. The inferior medial genicular nerve can be also targeted medial to the tibial
      plateau adjacent to the genicular vessels. Methylprednisolone acetate (MPA)(Depomedrol) is a
      lipophilic glucocorticoid commonly used in chronic pain procedures. It has a good safety
      record and its analgesic action can last from days to weeks.(8) The literature supporting its
      role as an adjuvant to local anesthetic in peripheral nerve block are scanty. However, some
      studies showed that depo-methylprednisolone as an adjuvant to 0.5% lidocaine showed excellent
      results in neuropathic pain resulting from nerve injury. This study aims to evaluate the
      efficacy of adding depomedrol as an additive to bupivacaine in genicular nerve block for
      evaluating postoperative pain, opioid use, and ease of ambulation in patients undergoing TKA.
    

Intervention name(s): Methylprednisolone Injection; Bupivacaine Hcl 0.5% Inj_#2; normal saline
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Ultrasound-guided genicular nerve block comparing Methylprednisolone combined with Bupivacaine to bupivacaine alone. All patients will undergo TKA and will receive spinal anesthesia.; Ultasound- guided genicular nerve block using 5 ml bupivacaine 0.5% in 15 ml saline; Ultrasound guided genicular nerve infiltration with 20 ml normal saline as a placebo control.
Other intervention name(s): Depomedrol; Marcaine 0.5%; 0.9% saline
Intervention MeSH terms: Methylprednisolone; Methylprednisolone Acetate; Methylprednisolone Hemisuccinate; Prednisolone; Prednisolone acetate; Bupivacaine; Prednisolone hemisuccinate; Prednisolone phosphate
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients will be allocated into three equal parallel groups.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment