Comparison of the Effects of Trigonum Femoral + Distal Adductor Block and Adductor Canal + N.Tibialis Posterior Block on Postoperative Pain in Total Knee Replacement Surgery: A Multicenter Study

The study is planned to be conducted prospectively and multicenter after approval from the Clinical Research and Ethics Committee of Kahramanmaras Sütçü Imam University Health Practice and Research Hospital. Patients were randomly divided into 2 groups as Femoral Triangle Nerve Block + Distal Adductor Canal Block (Group A) and Adductor Canal Block + Tibialis Posterior Nerve Block (Group B) and Patient Controlled Analgesia (PCA) will be applied to both groups. Patients' oral intake will be stopped 8 hours before surgery as we routinely do in our clinic. All of our patients will be informed about the VAS questionnaire preoperatively so that various postoperative pain treatment methods can be applied. Patients admitted to the operating table will be monitored for heart rate, 3-lead ECG and pulse oximetry (SpO2) values, and vascular access will be established using a 20G catheter through the dorsum of the hand. While the patients are in the sitting position, aseptic conditions will be ensured and a 25 G Quincke spinal needle will be advanced through the appropriate intervertebral space (L3-L4 or L4-L5), passing through the skin, subcutaneous supraspinal ligament, interspinous ligament, ligamentum flavum, epidural space and dura to the subarachnoid space, and when it reaches the subarachnoid space, the chuck will be withdrawn and the free flow of spinal fluid will be observed. Then heavy marcain will be administered, the dose of which is determined according to the patient's height. After the level of sensory block is checked by pin prick test and motor block is checked by Bromage method, the operation will be started. In the last half hour of the operation, 100 mg tramadol+1 g paracetamol IV will be administered to the patients of both groups. At the end of the operation, patients will be taken to the operating room postoperative recovery room. Patients in Group A will undergo Ultrasound guided Femoral Triangle Nerve + Distal Adductor technique block postoperatively by anesthesiologist (specialist) . The same volume of local anesthetic will be used in the groups, “10 mL bupivacaine 0.25%” for a single block type and “20 mL bupivacaine 0.25%” in total. After the blocks are performed, patient-controlled analgesia (PCA) will be applied to the patients from the recovery room and they will be followed up with a data monitoring form. Age, gender, body mass index, ASA scores, duration of surgery and preoperative VAS values will be recorded. IV patient-controlled analgesia with 1 mg/cc tramadol will be started in the postoperative period. The bolus dose will be 20 mg without basal infusion and the lock time will be set to 15 min. When VAS values exceed 4 in patient follow-up, 75 mg diclofenac sodium IM will be administered as rescue analgesic and recorded as additional analgesic requirement. Patients will be visited in the ward at 8, 12, and 24 hours postoperatively; the first time they used the patient-controlled pain device, the values obtained with the visual analog scale (VAS with 0-10 cm scale), and the 24-hour tramadol consumption of all patients in milligrams and the additional analgesic demand will be recorded on the postoperative follow-up forms. Patients' satisfaction levels at the end of the 24th hour will also be assessed with a four-point Likert scale (very good, good, fair, and poor) and quality of recovery will be assessed with the QOR-15 questionnaire.