Analgesic Efficacy of Adding SCB With Low Concentration Bupivacaine Combined With Dexamethasone on Pain After TKA

Study Overview
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Brief Summary
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This study evaluate the efficacy of adding popliteal sciatic nerve block with low concentration bupivacaine and dexamethasone to abductor canal block for total knee arthroplasty in patient with NSAIDs prescribing precaution. Half of participants will receive popliteal sciatic nerve block, abductor canal block and periarticular injection, while the other half will receive a sham block, abductor canal block and periarticular injection.

Detailed Description
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After informed and consent, all patients will be devided into two groups, Sciatic group (group S) and Controlled group (group C). All patients will receive adductor canal block, then patients in group S will receive Sciatic nerve block with low concentration bupivacaine and dexamethasone while partients in group C will receive sham block. All patient will receive spinal anesthesia and intraoperative periarticular injection. Postoperative pain score, muscle strength, total morphine consumption and adverse events will be record in case record form.

Official Title
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Analgesic Efficacy of Adding SCB With Low Concentration Bupivacaine Combined With Dexamethasone to ACB and Periarticular Injection on Postoperative Pain After TKA: Randomized Controlled Study

Conditions
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Total Knee Arthroplasty, Adductor Canal Block, Sciatic Nerve Block

Intervention / Treatment
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* Drug: bupivacaine and dexamethasone
* Drug: bupivacaine and lidocaine
* Device: Ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patient scheduled for single total knee arthroplasty patient with NSAIDs prescribing precautions such as history of NSAIDs allergy, Chronic kidney disease (GFR< 50 ml/min), history of ischemic heart disease or cerebrovascular disease Exclusion Criteria: patient refusal body weight less than 45 kg history of allergy to bupivacaine or dexamethasone uncontrolled diabetes mellitus contraindicated for spinal block, adductor canal block or sciatic nerve block inability to assess pain score (cognitive or psychiatric history) patient scheduled for revision TKA preexisting neuropathy or neurological deficit in lower extremity preexisting chronic pain (prolonged use of oral morphine 20 mg/day or equivalent)

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 85 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
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: control group<br>adductor canal block with sham block | Drug: bupivacaine and lidocaine<br>* adductor canal block with 0.33% bupivacaine 15 ml with ultrasound at popliteal sciatic area and subcutaneous infiltration popliteal area with 2% lidocaine 1 ml<br>Device: Ultrasound<br>* ultrasound<br>|
| Experimental: sciatic group<br>adductor canal block with popliteal sciatic nerve block | Drug: bupivacaine and dexamethasone<br>* adductor canal block with 0.33% bupivacaine 15 ml with ultrasound guided popliteal sciatic block with 0.125% bupivacaine 20 ml and dexamethasone 5 mg<br>* Other names: bupivacaine;Device: Ultrasound<br>* ultrasound<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain score at rest | postoperative pain score at rest at 24 hour | postoperative 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain score at anterior and posterior site of knee | postoperative pain score at anterior and posterior site of knee at 24 hour | postoperative 24 hours | 
| postoperative pain score on 45 degree knee flexion and physical therapy | postoperative pain score on 45 degree knee flexion and physical therapy | postoperative 24 hours | 
| level of tibialis anterior muscle weakness | level of tibialis anterior muscle weakness in 24 hour | postoperative 24 hours | 
| adverse events | perioperative adverse events such as LAST, hypotension, nausea and vomitting | postoperative 24 hours | 
| total morphine consumption in postoperative 24 hours | total morphine consumption in postoperative 24 hours | postoperative 24 hours | 
| patient satisfaction | patient satisfaction score | postoperative 24 hours | 
| length of hospital stay | length of hospital stay | 7 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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popliteal sciatic nerve block, total knee artgroplasty, adductor canal block, dexamethasone