Adductor Canal Block Versus Lumbar Plexus Block for Post Operative Pain Management After Total Knee Replacement

Study Overview
=================
Brief Summary
-----------------
Adductor canal block (ACB), Saphenous nerve block, which is a block of a purely sensory nerve which shares in nerve supply of knee joint has a hypothetical advantage of better pain management with less motor affection. Also, it has a clear anatomical landmark that will increase the success rate (femoral artery) (*).On the other hand, being a branch of the femoral nerve and far distal from the plexus, this can decrease the blocking effectiveness. Likewise, the great variation of the knee nerve supply. This prospective double-blinded randomized controlled trial is comparing ultrasound guided adductor canal block (ACB) versus ultrasound-guided lumbar plexus block (LPB) in patients undergoing total knee arthroplasty aiming at decreasing post-operative pain, helping in early mobilization and better physiotherapy. This study hypothesizes that ACB, compared with LPB, will exhibit less motor, weakness, fewer opioids consumption with the same or better pain score.

Detailed Description
-----------------
This prospective double-blinded randomized controlled trial is comparing ultrasound guided adductor canal block (ACB) versus ultrasound-guided lumbar plexus block (LPB) in patients undergoing total knee arthroplasty aiming at decreasing post-operative pain, helping in early mobilization and better physiotherapy. This study hypothesizes that ACB, compared with LPB, will exhibit less motor, weakness, fewer opioids consumption with the same or better pain score.

Official Title
-----------------
Adductor Canal Block Versus Lumbar Plexus Block for Post Operative Pain Management After Total Knee Replacement

Conditions
-----------------
Pain Management

Intervention / Treatment
-----------------
* Procedure: Ultrasound-guided Lumber Plexus Block
* Procedure: adductor canal block


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: ASA I-II Age more than 25 and less than 80 were included Exclusion Criteria: Patients with known allergy to the medications to be given ASA III, IV Age less than 25 or more than 80 Dementia Deafness Psychological disease Difficult to communicate Cannot lay flat INR more than 1.5 Low platelets (less than 100000/ml3) or with significant coagulopathy

Ages Eligible for Study
-----------------
Minimum Age: 35 Years
Maximum Age: 80 Years

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

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

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

Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: group (A) lumber plexus block<br>Ultrasound-guided Lumber plexus Block (30 cc of 0.25% of bupivacaine, via a 22-gauge 2-inch Stimuplex A needle) with nerve stimulator confirmation. | Procedure: Ultrasound-guided Lumber Plexus Block<br>* (30 cc of 0.25% of bupivacaine, via a 22-gauge 2-inch Stimuplex A needle) with nerve stimulator confirmation. The type of motor response (e.g., quadriceps, patellar) and the minimum current needed were recorded. Ultrasound pictures (preinjection and postinjection) were obtained to verify proper local anesthetic placement.<br>|
| Experimental: Group (B) adductor canal block<br>ultrasound-guided Adductor Canal Block (15 cc of 0.5% of bupivacaine) | Procedure: adductor canal block<br>* ultrasound-guided Adductor Canal Block (15 cc of 0.5% of bupivacaine)<br>* Other names: saphenous nerve block;|

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

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain | pain assessment using visual analogue scale | 2 hours |