Epidural Analgesia vs Adductor Canal Block in Bilateral TKA

Study Overview
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Brief Summary
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This study evaluates postoperative analgesic efficacy within 48 hours between epidural analgesia and single-shot bilateral adductor canal blocks in bilateral total knee arthroplasty. Half of participants will be received continuous epidural analgesia, while other half of participants will be received single-shot bilateral adductor canal blocks.

Detailed Description
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Continuous epidural analgesia is effective postoperative pain control but it has some limitations in patients with hypotension, concurrent anticoagulants, technical difficulty, urinary retention. Adductor canal block is less invasive than continuous epidural analgesia. It provides effective analgesia for total knee arthroplasty and preserves quadriceps muscle strength.

Official Title
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Comparison Efficacy of Analgesic Techniques: Continuous Epidural Analgesia Versus Bilateral Single-shot Adductor Canal Blocks in Patients Undergoing Bilateral Total Knee Arthroplasty

Conditions
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Osteo Arthritis Knee

Intervention / Treatment
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* Procedure: Continuous epidural block
* Procedure: Bilateral single-shot bilateral adductor canal blocks


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged more than 18 years old undergoing bilateral total knee arthroplasty American Society of Anesthesiologists physical status classification 1-3 Exclusion Criteria: Participants deny to enroll the study Allergy to bupivacaine Weight less than 50 kilograms Hepatic disease Contraincation for neuraxial block or adductor canal block Uncontrolled cardiovascular disease Creatinine clearance less than 50 ml/min

Ages Eligible for Study
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Minimum Age: 18 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Epidural analgesia<br>Lumbar continuous epidural block | Procedure: Continuous epidural block<br>* Continuous epidural block at level L2-3 or L3-4 with 0.0625% bupivacaine + fentanyl 2 mcg/ml infusion epidurally 5 ml/hr for 48 hours postoperatively.<br>|
| Experimental: Bilateral ACB<br>Ultrasound-guided bilateral adductor canal blocks | Procedure: Bilateral single-shot bilateral adductor canal blocks<br>* Bilateral single-shot adductor canal blocks, ultrasound guidance, with 0.33% bupivacaine 15 ml on each side.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain scores at rests | numerical rating scales | 48 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| morphine consumptions | total miligrams of morphine use in each arm | 48 hours postoperatively | 
| pain scores on movement | numerical rating scales | 48 hours postoperatively | 
| side effects of interventions | nausea vomiting hypotension | 48 hours postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Continuous epidural analgesia, Bilateral single-shot adductor canal blocks