Continuous Adductor Canal Block for Total Knee Arthroplasty Analgesia

Study Overview
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Brief Summary
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The purpose of the study is to determine whether the association of sciatic nerve block to continuous adductor canal block is effective in the treatment of total knee arthroplasty post operative pain .

Official Title
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Prospective Comparison Between Continuous Femoral Nerve Block and the Association of Adductor Canal Block and Sciatic Nerve Block in Total Knee Arthroplasty.

Conditions
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Neuromuscular Blockade, Pain Management

Intervention / Treatment
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* Procedure: Continuous femoral nerve block
* Procedure: Continuous adductor canal block
* Procedure: infragluteal Sciatic nerve block
* Drug: Ropivacaine 0.2%
* Drug: Saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elective unilateral TKA, Planned continuous spinal anesthesia , Ability to follow study protocol, American Society of Anesthesiologists class 1 to 3. Exclusion Criteria: Contraindication for neuraxial anesthetic, Chronic opioid use (defined as daily or almost daily use of opioids for >3 months), Hypersensitivity and/or allergies to any of the study medications, Intraoperative use of volatile anesthetics, Preexisting neuropathy on the operative limb, Contraindications to a femoral, adductor canal or Tibial nerve block.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 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: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Continous femoral nerve block<br>Patients will receive ultrasound-guided (USG) continuous femoral nerve block with 20 ml ropivacaine 0.2% and USG Continuous adductor canal block with 20 ml of saline and USG infragluteal SNB with 20 ml of saline . | Procedure: Continuous femoral nerve block<br> <br> Procedure: Continuous adductor canal block<br> <br> Procedure: infragluteal Sciatic nerve block<br> <br> Drug: Ropivacaine 0.2%<br> <br> Drug: Saline<br> <br> |
| Experimental: Continuous adductor canal block<br>Patients will receive ultrasound-guided continuous adductor canal block with 20 ml ropivacaine 0.2% and USG infragluteal SNB with 20 ml ropivacaine 0.2% and USG continuous FNB with 20 ml of saline . | Procedure: Continuous femoral nerve block<br> <br> Procedure: Continuous adductor canal block<br> <br> Procedure: infragluteal Sciatic nerve block<br> <br> Drug: Ropivacaine 0.2%<br> <br> Drug: Saline<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Opioid-consumption | Cumulative opioid consumption : converting oral, intravenous, and patient-controlled analgesia PCA opioid to morphine equivalent | 8 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NRS pain score at rest | NRS pain scores determined by patient interview, using the standard NRS of 0 to 10 scale at rest. | 0,1,2,4,6,8,12,24 and 48 hours postoperative | 
| NRS pain score during movement | NRS pain scores determined by patient interview, using the standard NRS of 0 to 10 scale, during physiotherapy. | 0,1,2,4,6,8,12,24 and 48 hours postoperative | 
| NRS pain score after 10 meters of walk or maximum walked distance | NRS pain scores determined by patient interview, using the standard NRS of 0 to 10 scale after 10 meters walk (if enable after maximum walked distance). | 8, 24 and 48 hours postoperative | 
| Ability to walk | The ability of the patient to stand up and walk 3 meters. | 8, 24 and 48 hours postoperative | 
| TUG Test | The TUG test measures the time it takes a patient to stand up from a chair, walk a distance of 3 m, and return to the chair | 8, 24 and 48 hours postoperative | 
| The 10-m walk test | time it takes the patient to walk a distance of 10 m as quickly as possible | 8, 24 and 48 hours postoperative | 
| patient satisfaction | patient interviewed, using a scale of 0-10, 0 not satisfied and 10 being the most satisfied | 8, 24 and 48 hours postoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Total knee replacement, analgesia, nerve block