Comparison of Regional Anesthesia Techniques After Total Knee Arthroplasty
Condition: Pain, Acute; Knee Arthropathy; Postoperative Pain; Mobility Limitation
MeSH terms: Acute Pain; Mobility Limitation
Study type: Interventional

Summary: 
      Comparison of continuous adductor canal block to continuous femoral nerve block in patients
      after total knee arthroplasty.

      All patients will be anesthetized with spinal anesthesia. Continuous infusion of ropivacaine
      with a catheter implemented to the adductor canal or next to the femoral nerve.

      The observed goals: pain intensity, the beginning and quality of rehabilitation.
    

Detailed description: 
      Written consent will be obtained a day before the surgery. Only subarachnoidally
      anaesthetised patients may participate in the study. Pencil-point spinal needle and
      bupivacaine (Marcaine Heavy Spinal 0.5 %) will be used.

      Before the beginning of operation, under ultrasound control, a catheter will be implemented
      to one of the chosen position: the adductor canal (the middle or lower third of thigh) or
      near the femoral nerve (below the inguinal ligament). The local anesthetic solution of 0.2 %
      ropivacaine will be started with an elastomeric pump (5 mL per hour, up to 72 hours) as soon
      as a catheter in the right position.

      The pain will be measured with VAS (visual-analogue scale) 8, 24 and 48 hours after the end
      of operation, and at the discharge. At the same time, i.e.: 8, 24 and 48 hours from the end
      of surgery, the range of flexion and extension in the operated knee will be assessed.
      Moreover, the possibility of patient's sitting, standing up and walking will be noted.

      All parameters will be reassessed before patients' discharge from the hospital. Each patient
      will receive paracetamol (1.0) and metamizol (1.0) intravenously (i.v.) q6h. 5 mg of morphine
      may be given as required, up to 2 dosages per day as a rescue medication.
    

Intervention name(s): continuous anesthesia of adductor canal; continuous anesthesia of femoral nerve; Spinal anesthesia
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): After subarachnoid anesthesia, but before the beginning of surgery, a catheter will be implemented to the adductor canal and infusion of 5 mL/h of 0.2 % ropivacaine will be started.; After subarachnoid anesthesia, but before the beginning of surgery, a catheter will be implemented next to the femoral nerve (below inguinal ligament) and infusion of 5 mL/h of 0.2 % ropivacaine will be started.; Before the beginning of surgery all patients will be anesthetised with 0.5 % hyperbaric bupivacaine (Marcaine Heavy), 2.0 - 2.5 mL solution. Pencil point spinal needle will be used.
Other intervention name(s): Subarachnoid anesthesia
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two groups of patients randomly allocated: adductor canal group or femoral nerve group
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: regional anesthesia; knee replacement; pain treatment; rehabilitation