Adductor Canal Block, Femoral Nerve Block, Total Knee Arthroplasty, Total Knee Replacement
Conditions
Brief summary
The blockade of the femoral nerve (FNB) is the most common postoperative pain therapy after total knee replacement. Because of motor-driven weakness of the quadriceps muscle induced by femoral nerve block mobilization of Patients is difficult even dangerous (falls) and hospital stays are extended. An alternative method could be an adductor canal block (ACB). Anatomical studies of the adductor canal demonstrated that the adductor canal contains the saphenous nerve, a pure sensory nerve for medial and anterior aspects of the knee and the tibia without any motor function. This prospective, double-blinded, randomized study investigates the effect of FNB and ACB on quadriceps motor weakness and analgesia determined by Numeric Rating Scale (NRS). We expect the ACB to be superior in muscle strength but equal in pain score. Both groups receive an additional anterior sciatic nerve block for complete sensory block of the operated knee
Interventions
DRUGRopivacaine
Regional Anesthesia performed with 0.375% Ropivacaine 15ml (56,25mg)
Sponsors
Philipps University Marburg
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
50 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* patients with knee replacement therapy and general anaesthesia * informed consent * preoperative timed up and go test performable
Exclusion criteria
* emergency patients * BMI \> 40 kg/m2 * American Society of Anaesthesiologists physical status (ASA) 4-5 * severe chronic obstructive pulmonary disease (COPD) * rheumatic arthritis, diabetic Polyneuropathy, M. Parkinson * nerve injury of lumbosacral plexus * coagulopathy with bleeding tendency * not capable of speaking or understanding german or english
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Timed-Up and Go-test for mobility evaluation | third postoperative day | The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CAS (Cumulated Ambulation Score) | 24,48,72 hours postoperative | Cumulated Ambulation Score is calculated with routine data. Measurement for ambulation ability |
| Pain Scores | 6, 24, 48, 72 hours postoperative | Numeric Rating Scale (NRS), 0-10 for Rest / Stress. in Addition total Body NRS Pain |
| Ropivacaine consumption (each catheter) | 24, 48, 72 hours postoperative | Measurement of the total amount |
| Mobility Score (MoSc) | 24,48,72 hours postoperative | Is calculated with routine data. Measurement for overall mobilization (none- passive mobilization, sitting, standing, walking with walking device, walkin free or with crutches) |
| Analgesic regimen | preop and 0, 6 , 24, 48, 48 hours postoperative | Documentation of analgesic prescriptions and rescue medications during postoperative course |
| Quadriceps strength | 6, 24, 28, 72 hours postoperative | Numeric Scale (0-5) |
Countries
Germany
Outcome results
None listed