Single Shot Versus Continuous Adductor Canal Block in Patients Undergoing Total Knee Arthroplasty

Study Overview
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Brief Summary
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Adductor canal block (ACB) has emerged as an option for postoperative regional analgesia in patients undergoing total knee arthroplasty (TKA).

Detailed Description
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Various approaches to the performance of peripheral nerve blocks for postoperative pain control in patients undergoing TKA have been described in the literature. These approaches include lumbar plexus block, femoral nerve block (FNB), with or without a sciatic nerve block, and most recently the ACB. FNB is a commonly used modality for postoperative analgesia after TKA. It is considered by some as the gold standard or the cornerstone of postoperative analgesia after TKA. However, FNB reduces quadriceps muscle strength essential for mobilization and active contribution in any physical rehabilitation program. Quadriceps weakness places the patients at risk of falling. which may be detrimental to postoperative recovery. The ACB has recently emerged as an appealing alternative to FNB as it is predominately a sensory nerve block of a more distal branch of the femoral nerve ( the saphenous nerve).

Official Title
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Comparison Between the Analgesic Effects of Single Shot Versus Continuous Adductor Canal Block in Patients Undergoing Total Knee Arthroplasty

Conditions
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Rheumatism Knee

Intervention / Treatment
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* Procedure: single-shot adductor canal block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for primary total knee arthroplasty with American Society of Anesthesiologists (ASA) physical status I -III, mentally competent and able to give consent for enrollment in the study. Exclusion Criteria: Patient younger than 18 years old or older than 70 years old Allergy to local anesthetics, systemic opioids (fentanyl, morphine, hydromorphone, and any of the drugs included in the multimodal perioperative pain protocol. Revision surgeries were excluded. Impaired kidney functions and patients with coagulopathy were also excluded. Chronic pain syndromes and patients with chronic opioid use defined as the use of regular daily doses of systemic narcotics for the past 6 months prior to the surgery. BMI of 40 or more Pregnancy (positive urine pregnancy test result in Preop area on the morning of surgery)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 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
Interventional Model Description: The target population of this study will be patients undergoing primary total knee arthroplasty at Aswan l and Assiut university hospitals
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Single shot adductor canal block<br>Following sterile preparation and draping, an ultrasound survey of the medial thigh was performed, halfway between the superior anterior iliac spine and the patella. The superficial femoral artery has been identified beneath the sartorius muscle in a short-axis view, with the vein just inferior and the saphenous nerve just lateral to the artery. A 20 Gauge, 120 mm, non-cuttings tip echogenic needle (SonoPlex STIM, Germany) needle was introduced in-plane, and 2 to 3 mL of LA bolus (0.25 % Bupivacaine) was used to confirm proper needle placement in the adductor canal near the saphenous nerve. Then, a bolus of 20 ml of Bupivacaine 0.25 % was injected through the needle | Procedure: single-shot adductor canal block<br>* An ultrasound machine (Philips; Model: OTD020, AcBel Polytech Inc., Taiwan) with a 5-10 MHz linear probe was used to perform the adductor canal block immediately postoperatively.<br>* Other names: Saphenous nerve block;|
| Active Comparator: Continuous adductor canal block<br>a catheter was secured in place using Tegaderm. The catheters were connected to a pump that infused local anesthetic, 20 mL of 0.25 % bupivacaine, followed by 48 hours of continuous infusion of 0.125 % bupivacaine at 5 mL/h. | Procedure: single-shot adductor canal block<br>* An ultrasound machine (Philips; Model: OTD020, AcBel Polytech Inc., Taiwan) with a 5-10 MHz linear probe was used to perform the adductor canal block immediately postoperatively.<br>* Other names: Saphenous nerve block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain scores by visual analogue score | visual analogue score is a straight, vertical 10-cm line with the bottom point representing no pain = (0cm) and the top point representing the worst pain you could ever have = (10 cm). | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| time to up and go test (minutes) | determines how long it takes a person to get out of a chair | 48 hours | 
| six-minute walking test | calculates the distance that can be walked in 6 minutes | 48 hours | 
| the 30-Second Chair test | determines how many times a person can rise from a chair and sit down again in 30 seconds while keeping their arms crossed over their chest | 48 hours |