Adductor Canal Block, Sciatic Nerve Block, Total Knee Arthroplasty
Conditions
Keywords
popliteal sciatic nerve block, total knee artgroplasty, adductor canal block, dexamethasone
Brief summary
This study evaluate the efficacy of adding popliteal sciatic nerve block with low concentration bupivacaine and dexamethasone to abductor canal block for total knee arthroplasty in patient with NSAIDs prescribing precaution. Half of participants will receive popliteal sciatic nerve block, abductor canal block and periarticular injection, while the other half will receive a sham block, abductor canal block and periarticular injection.
Detailed description
After informed and consent, all patients will be devided into two groups, Sciatic group (group S) and Controlled group (group C). All patients will receive adductor canal block, then patients in group S will receive Sciatic nerve block with low concentration bupivacaine and dexamethasone while partients in group C will receive sham block. All patient will receive spinal anesthesia and intraoperative periarticular injection. Postoperative pain score, muscle strength, total morphine consumption and adverse events will be record in case record form.
Interventions
adductor canal block with 0.33% bupivacaine 15 ml with ultrasound guided popliteal sciatic block with 0.125% bupivacaine 20 ml and dexamethasone 5 mg
adductor canal block with 0.33% bupivacaine 15 ml with ultrasound at popliteal sciatic area and subcutaneous infiltration popliteal area with 2% lidocaine 1 ml
DEVICEUltrasound
ultrasound
Sponsors
Mahidol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
50 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* patient scheduled for single total knee arthroplasty * patient with NSAIDs prescribing precautions such as history of NSAIDs allergy, Chronic kidney disease (GFR\< 50 ml/min), history of ischemic heart disease or cerebrovascular disease
Exclusion criteria
* patient refusal * body weight less than 45 kg * history of allergy to bupivacaine or dexamethasone * uncontrolled diabetes mellitus * contraindicated for spinal block, adductor canal block or sciatic nerve block * inability to assess pain score (cognitive or psychiatric history) * patient scheduled for revision TKA * preexisting neuropathy or neurological deficit in lower extremity * preexisting chronic pain (prolonged use of oral morphine 20 mg/day or equivalent)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| postoperative pain score at rest | postoperative 24 hours | postoperative pain score at rest at 24 hour |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| postoperative pain score on 45 degree knee flexion and physical therapy | postoperative 24 hours | postoperative pain score on 45 degree knee flexion and physical therapy |
| level of tibialis anterior muscle weakness | postoperative 24 hours | level of tibialis anterior muscle weakness in 24 hour |
| adverse events | postoperative 24 hours | perioperative adverse events such as LAST, hypotension, nausea and vomitting |
| postoperative pain score at anterior and posterior site of knee | postoperative 24 hours | postoperative pain score at anterior and posterior site of knee at 24 hour |
| patient satisfaction | postoperative 24 hours | patient satisfaction score |
| length of hospital stay | 7 days | length of hospital stay |
| total morphine consumption in postoperative 24 hours | postoperative 24 hours | total morphine consumption in postoperative 24 hours |
Countries
Thailand
Contacts
Primary ContactBusara Sirivanasandha, MD
Outcome results
None listed