The Appropriate Level of Continuous Adductor Canal Block in Patients Undergoing Total Knee Arthroplasty (TKA)

Study Overview
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Brief Summary
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Adductor canal catheters are being used to provide continuous postoperative analgesia after total knee arthroplasty surgery (TKA). There is much debate about where is the best position of continuous adductor canal block in patients undergoing TKA. Therefore, the investigators aim to compare the postoperative pain at three different level of continuous adductor canal block. Ninety six patients scheduled for total knee arthroplasty will be randomly divided into the three groups. In group 1, the adductor canal catheter is inserted at femoral triangle apex (the proximal end of the adductor canal). In group 2, the adductor canal catheter is inserted femur length/15*2 cm above the location where the nerve block performed in group 1. In group 3, the adductor canal catheter is inserted femur length/15cm below the location where the nerve block performed in group 1.

Official Title
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The Appropriate Level of Continuous Adductor Canal Block in Patients Undergoing Total Knee Arthroplasty (TKA)

Conditions
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Degenerative Arthritis

Intervention / Treatment
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* Procedure: the three different sites of continous adductor canal block: the adductor canal catheter is inserted at femoral triangle apex
* Procedure: the three different sites of continous adductor canal block: the adductor canal catheter is inserted femur length/15*2 cm above the location
* Procedure: the three different sites of continous adductor canal block: the adductor canal catheter is inserted femur length/15 cm below the location


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. Patients undergoing total knee arthroplasty Exclusion Criteria: 1. Patients who have infection or had surgery on the thigh 2. The subject is a foreigner or illiterate 3. Patients who have cognitive dysfunction

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Ninety six patients scheduled for total knee arthroplasty will be randomly divided into the three groups. In group 1, the adductor canal catheter is inserted at femoral triangle apex (the proximal end of the adductor canal). In group 2, the adductor canal catheter is inserted femur length/15*2 cm above the location where the nerve block performed in group 1. In group 3, the adductor canal catheter is inserted femur length/15*2 cm below the location where the nerve block performed in group 1.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group 1(femoral triangle apex)<br>the adductor canal catheter is inserted at femoral triangle apex (the proximal end of the adductor canal) | Procedure: the three different sites of continous adductor canal block: the adductor canal catheter is inserted at femoral triangle apex<br>* In group 1, the adductor canal catheter is inserted at femoral triangle apex (the proximal end of the adductor canal).<br>|
| Active Comparator: Group 2(femur length/15*2 cm above)<br>the adductor canal catheter is inserted femur length/15*2 cm above the location where the nerve block performed in group 1 | Procedure: the three different sites of continous adductor canal block: the adductor canal catheter is inserted femur length/15*2 cm above the location<br>* In group 2, the adductor canal catheter is inserted femur length/15*2 cm above the location where the nerve block performed in group 1.<br>|
| Active Comparator: Group 3(femur length/15 cm below)<br>the adductor canal catheter is inserted femur length/15cm below the location where the nerve block performed in group 1. | Procedure: the three different sites of continous adductor canal block: the adductor canal catheter is inserted femur length/15 cm below the location<br>* In group 3, the adductor canal catheter is inserted femur length/15 cm below the location where the nerve block performed in group 1.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain : Visual Analogue Scale (VAS) for pain | The visual analog scale(VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between no pain (0) and worst pain. (10). The ends are defined as the extreme limits of the parameter to be measured(symptom,pain,health) orientated from the left(0, worst) to the right(10, best). | Baseline (Before surgery) | 
| Pain : Visual Analogue Scale (VAS) for pain | The visual analog scale(VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between no pain (0) and worst pain. (10). The ends are defined as the extreme limits of the parameter to be measured(symptom,pain,health) orientated from the left(0, worst) to the right(10, best). | postoperative day 1 | 
| Pain : Visual Analogue Scale (VAS) for pain | The visual analog scale(VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between no pain (0) and worst pain. (10). The ends are defined as the extreme limits of the parameter to be measured(symptom,pain,health) orientated from the left(0, worst) to the right(10, best). | postoperative day 2 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| muscle strength | Quadriceps strength of both legs was assessed by placing the dynamometer on the anterior of the ankle, between the malleoli. | Baseline (Before surgery) | 
| muscle strength | Quadriceps strength of both legs was assessed by placing the dynamometer on the anterior of the ankle, between the malleoli. | postoperative day 1 | 
| muscle strength | Quadriceps strength of both legs was assessed by placing the dynamometer on the anterior of the ankle, between the malleoli. | postoperative day 2 |