Analgesia post Total Knee Replacement surgery - Comparision between Local Infiltration Analgesia and Ultrasound Guided Single Shot Adductor Canal Block.

Title of the Study Comparison between Local Infiltration Analgesia (LIA) and Ultrasound Guided Single Shot Adductor Canal Block (UG-SS-ACB) for post-operative pain relief in patients undergoing Total Knee Replacement surgery. Methods: All 60 patients enrolled for the study will receive spinal anesthesia with 0.5% bupivacaine heavy 2.8 ml with Fentanyl 20 microgram(Total volume = 3.2 ml), prior to surgery. The spinal Anesthetic will be administered in the Operation Theater (as it is the Hospital protocol). The patient will be wheeled to the operation theater and standard monitoring i.e. Electrocardiography(ECG), Pulse oximetry and Noninvasive blood pressure. After completion of the WHO surgical safety checklist and “Sign - in”, the patient will be placed in a sitting position. After proper aseptic procedures including painting the lower back with Betadine solution, a local anesthetic solution containing 1% Lidocaine 2mls will be injected in L3 - L4 interspace. Dural Puncture will be performed with 25 G Pencil Point needle, and after confirming free flow of Cerebrospinal Fluid, 3.2 ml of above-mentioned solution will be injected. There Patient will be placed in a supine position and the table tilt will be adjusted to achieve a block height between T12 and T8 sensory level. After confirming a minimum of T12 sensory level the surgical team will be allowed to clean and sterilize the limb and proceed to start the surgery. The approximate time of start of surgery from the time of spinal anesthetic in our routine cases is 30 minutes. Group A patients will be given local infiltration analgesia at the end of surgery which will be injected at the posterior capsule (40 ml), anterior capsule (40 ml), patellar tendon (25 ml), quadriceps tendon(25 ml) and subcutaneous tissue at incision line(20 ml). The local infiltration analgesia will be prepared using a mixture of 50 ml of 0.25% bupivacaine, 10mg morphine [1ml] and 99 ml normal saline to make a volume of 150 ml. Group B patients will be given adductor canal block under ultrasound guidance with 25 ml 0.5% bupivacaine at the mid-thigh level at the end of surgery. Postoperatively all patients will be given Patient Controlled Analgesia(PCA) morphine 1mg bolus with a lockout of 5 minutes, the 4 hourly limits being 30 mg. In addition, all patients will receive oral paracetamol 1g every 6 Hourly and diclofenac 50mg every 8 hourly, for 24 hours starting from the end of the surgery. The Pain management team, which consists of dedicated pain management nurses, will be notified to follow the patient and collect the data at the end of 24 hours. The pain management team will be blinded to the intervention the patient received. This team will follow up with the patient at 24 hours and collect and record the data on the data collection sheet(attached in the section of documents).