Single-shot Adductor Canal Block With Levobupivacaine and Dexmedetomidine in Total Knee Arthroplasty

Study Overview
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Brief Summary
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Total knee arthroplasty surgery is associated with severe postoperative pain and adequate pain management is necessary for early postoperative mobilization and rehabilitation. Although good postoperative pain control may be achieved by continuous epidural anesthesia or femoral nerve block, both methods have adverse effects such as muscle weakness, which may delay postoperative mobilization.

Detailed Description
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The adductor canal block (ACB) is a relatively new block providing analgesia for knee surgery, which not only blocks the largest sensory branch of the femoral nerve but also results in less reduction of quadriceps muscle strength, compared with the femoral nerve block (FNB) in adult patients. Randomized controlled trials have revealed that ACB provides at least equal analgesia as FNB, preserves quadriceps muscle strength better than FNB, and thus allowing for functional recovery within the first 24-hour post-TKA. However, one important limitation of single-shot peripheral nerve block is the short duration of analgesia. Because the average duration of severe pain after TKA takes 2-3 days, a continuous ACB via catheter would seem to be a good choice. Unfortunately, perineural catheters may be technically difficult to insert, are prone to premature dislodgement, and may increase infection risk. There also were some case reports of local anesthetic-induced myotoxicity after continuous ACB.

Official Title
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Analgesic Efﬁcacy of Single-shot Adductor Canal Block With Levobupivacaine and Dexmedetomidine in Total Knee Arthroplasty: a Randomized Clinical Trial

Conditions
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Adductor Canal Block, Levobupivacaine, Dexmedetomidine

Intervention / Treatment
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* Drug: Dexmedetomidine Hydrochloride
* Drug: Levobupivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA physical status I or II undergoing elective primary total knee arthroplasty surgery under spinal anesthesia. Exclusion Criteria: Patients with a known history of significant hepatic, renal, heart disease, autoimmune disease, any known convulsive disorder, any psychiatric disorders, chronic pain, pregnant females, regular use analgesics, anti-depressants, or opioids in the previous 2 months, revision surgery, morbid obesity, allergy to local anesthetics or morphine

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 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 |
| --- | --- |
| Experimental: L group<br>20 mL of 0.25% levobupivacaine plus 1 mL normal saline | Drug: Levobupivacaine<br>* 20 mL of 0.25% levobupivacaine plus 1 mL normal saline<br>|
| Experimental: LD group<br>20 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine | Drug: Dexmedetomidine Hydrochloride<br>* 20 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the first analgesia rescue call. | time to the first analgesic request. | 24 hours postoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dexmedetomidine, levobupivacaine, Adductor Canal Block