ESPB and ACB in Knee Arthroplasty

Study Overview
=================
Brief Summary
-----------------
Total knee arthroplasty surgery is preferred in the treatment of osteoarthritis and causes severe postoperative pain. In this study, we aimed to investigate the effects of lumbar erector spina plan block and adductor canal block on postoperative pain and quadriceps muscle strength in patients who underwent total knee arthroplasty with spinal anesthesia.

Detailed Description
-----------------
In a prospective, randomized study; Medeniyet University Faculty of Medicine Göztepe Prof. Dr. Forty patients who underwent total knee arthroplasty surgery at Süleyman Yalçın City Hospital were divided into two groups. After the surgery was completed, erector spina plane block was applied to Group E (n=20) patients with 20 ml of 0.25% bupivacaine from the operated side L3-L4 level, while in Group A (n=20) patients, in the area where the sartorius muscle crosses the adductor magnus muscle, it was lateral to the superficial femoral artery. Adductor canal block was applied to the adductor canal with 20 ml of 0.5% bupivacaine. All patients were administered 1 gr paracetamol and 75 mg diclofenac sodium when their pain started in the orthopedic ward. Numerical pain score and quadriceps muscle strength were evaluated during the 48-hour follow-up of the patients. When the pain score was 4 and above, 50 mg pethidine hydrochloride was administered.

Official Title
-----------------
Comparison of the Effects of Ultrasound-Guided Erector Spinae Plane Block and Adductor Canal Block on Postoperative Pain, Opioid Consumption and Quadriceps Muscle Strength in Total Knee Arthroplasty Surgery

Conditions
-----------------
Post Operative Pain

Intervention / Treatment
-----------------
* Procedure: Erector Spinae Plane Block
* Procedure: Adductor Canal Block


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: patients who underwent total knee arthroplasty surgery ASA I-III patients Exclusion Criteria: Patients with coagulopathy Patients history with local anesthetic allergy or toxicity Patients with long hospital stay Patients with advanced organ failure Mental retarded patients Presence of infection at the injection site

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Erector Plane Block Adductor Canal Block
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Erector Spinae Plane Block<br>Erector Spina Plane Block was performed to the patients after coplition of total knee arthroplasty operation for postopetaive pain. | Procedure: Erector Spinae Plane Block<br>* After the necessary asepsis and antisepsis procedures, the linear ultrasound probe was placed parasagittally 2-3 cm lateral to the spinous process at the L3 or L4 level and the transverse process was visualized. The peripheral block needle (85 mm B Braun Stimuplex A) was advanced in plane up to the transverse process and 10 ml 0.5% bupivacaine hydrochloride 10 ml 0.9% isotonic NaCl mixture was applied on the erector spina muscle.<br>|
| Active Comparator: Adductor Canal Block<br>Adductor Canal Block was performed to the patients after coplition of total knee arthroplasty operation for postopetaive pain. | Procedure: Adductor Canal Block<br>* After the necessary asepsis and antisepsis procedures, the linear ultrasound probe was placed in the middle between the medial condyle and the SIAS, and the superficial femoral artery (FSA) was visualized under the sartorius muscle. By following the FSA distally, the point where the sartorius muscle crosses the adductor magnus muscle, which is the beginning of the adductor canal, was found and the saphenous nerve was visualized hyperechoic in the anterolateral aspect of the FSA. 20 cc 0.5% bupivacaine hydrochloride was applied<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain 30 minute | Visual anolog score (1-10) | 30. min. | 
| Postoperative pain 1. hour | Visual anolog score (1-10) | 1. hour | 
| Postoperative pain 2. hour | Visual anolog score (1-10) | 2. hour | 
| Postoperative pain 6. hour | Visual anolog score (1-10) | 6. hour | 
| Postoperative pain 12. hour | Visual anolog score (1-10) | 12. hour | 
| Postoperative pain 24. hour | Visual anolog score (1-10) | 24. hour | 
| Postoperative pain 36. hour | Visual anolog score (1-10) | 36. hour | 
| Postoperative pain 48. hour | Visual anolog score (1-10) | 48. hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid consuption 30. min. | Petidine (mg) | 30. min. | 
| Opioid consuption 1. hour | Petidine (mg) | 1. hour | 
| Opioid consuption 2. hour | Petidine (mg) | 2. hour | 
| Opioid consuption 6. hour | Petidine (mg) | 6. hour | 
| Opioid consuption 12. hour | Petidine (mg) | 12. hour | 
| Opioid consuption 24. hour | Petidine (mg) | 24. hour | 
| Opioid consuption 36. hour | Petidine (mg) | 36. hour | 
| Opioid consuption 48. hour | Petidine (mg) | 48. hour | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Total Knee Arthroplasty, Erector Spinae Plane Block, Adductor Canal Block