Combined Adductor&Sciatic Nerve Block vs Femoral&Sciatic Nerve Block in Total Knee Replacement Surgery

Study Overview
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Brief Summary
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Knee joints, one of the largest and most functional joints of the human body, have great features to provide ideal body posture and movement. In patients with knee osteoarthritis in whom pain and functional loss continue to increase despite conservative and medical burden, they are evaluated by orthopedic surgeons for surgical treatment. Total knee replacement (TKR) surgery is aimed to eliminate the existing pain, restore and carry the movements, to protect the characteristics of the deformities and the quality of life. Pain can be very severe after TKR surgery, which is very common in the middle and elderly patient population today. In the postoperative period, untreated pain prevents early physical therapy practices and restricts postoperative knee rehabilitation and recovery, but it also has negative effects on the respiratory, gastrointestinal, renal, and central nervous systems. Effective management of postoperative acute pain can reduce these complications and the risk of developing chronic pain. In this study, investigators hypothesized that combined adductor canal and sciatic nerve block, applied with postoperative ultrasound guidance to patients who will undergo TKR surgery under general anesthesia, will provide effective analgesia, less opioid consumption, and faster ambulation time, similar to combined femoral and sciatic nerve block.

Detailed Description
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As a result of the power analysis investigators conducted for this study, the minimum sample size was calculated as 34 people for each group, 68 people in total, at the 95% confidence interval. 68 patients who meet the inclusion criteria will be included in our study. Patients will be randomized and divided into 2 groups. Accordingly, femoral and sciatic nerve blocks will be applied to 34 patients, and adductor canal and sciatic nerve blocks will be applied to 34 patients.

Official Title
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Comparing Combined Adductor Canal & Sciatic Nerve Block and Femoral & Sciatic Nerve Block for Postoperative Analgesia in Patients Undergoing Total Knee Replacement Surgery; A Prospective, Randomized, Controlled Study

Conditions
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Orthopedic Disorder, Total Knee Replacement, Post Operative Pain, Surgery

Intervention / Treatment
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* Procedure: Combine Adductor Canal & Sciatic Nerve Block
* Procedure: Combine Femoral & Sciatic Nerve Block
* Drug: Bupivacaine and prilocaine hydrochloride
* Drug: Bupivacaine and prilocaine hydrochloride


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ages of 40-85 ASA I-III Patients who will undergo total knee replacement surgery under general anesthesia Exclusion Criteria: Patients with deformity and pathology in the thigh region Clinically known local anesthetic allergy Clinically diagnosis of opioid, alcohol and substance dependence Patients who cannot perceive and evaluate pain such as psychiatric illness, mental retardation, dementia Morbid obesity (body mass index> 40 kg m2)

Ages Eligible for Study
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Minimum Age: 40 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: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group AS<br>The investigators will perform an adductor canal block and sciatic nerve block on that patient group for postoperative analgesia | Procedure: Combine Adductor Canal & Sciatic Nerve Block<br>* The investigators will perform a combined adductor canal & sciatic nerve block on that patient group for postoperative analgesia<br>Drug: Bupivacaine and prilocaine hydrochloride<br>* The investigators will perform a combined adductor canal & sciatic nerve block on that patient group for postoperative analgesia with bupivacaine and prilocaine hydrochloride<br>|
| Active Comparator: Group FS<br>The investigators will perform femoral and sciatic nerve blocks on that patient group for postoperative analgesia | Procedure: Combine Femoral & Sciatic Nerve Block<br>* The investigators will perform a combined femoral & sciatic nerve block on that patient group for postoperative analgesia<br>Drug: Bupivacaine and prilocaine hydrochloride<br>* The investigators will perform a combined femoral & sciatic nerve block on that patient group for postoperative analgesia with bupivacaine and prilocaine hydrochloride<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome measure of the study is the patients' postoperative pain scores (NRS) | Numerical rating scale (NRS) at 1, 6, 12, 18, 24, 48, 72th hours. NRS assessment score ranges from 0-10. 0 = no pain 10 = worst pain imaginable | 72 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The secondary outcome measure will be total opioid consumption in the first 72 hours postoperatively | PCA device will be prepared with 4 mg tramadol (400 mg/100 cc) per ml and total opioid consumption for 72 hours will be noted | Three days postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Femoral Nerve Block, Sciatic Nerve Block, Adductor Canal Block, General anesthesia, Orthopedic surgery, Post Operative Analgesia