Anesthesia, Conduction, Arthroplasty, Replacement, Knee, Pain, Postoperative, Anesthesia and Analgesia
Conditions
Keywords
Femoral nerve block, peripheral nerve block, Concentration, volume, bupivacaine, post operative analgesia, total knee arthroplasty
Brief summary
US-guided femoral nerve block is used effectively in post-operative pain management in the surgical treatment of the lower extremity. However, the volume and concentration of the local anesthetic drug to be administered remains controversial. In this prospective, randomized, double-blinded study, patients who underwent unilateral primary total knee arthroplasty and successfully performed spinal anesthesia with standard method and dosage, will be selected for US-guided femoral nerve block after the operation. Patients will be divided into three groups with simple randomization. The First group will be determined as the control group (GCont) and only dressing will be applied to the patients. For second group(G125), 0,125% 20 ml local anesthetic and for the third group (G25), 0,25% 10 ml local anesthetic will be administered to the femoral nerve without changing the drug dose (25 mg bupivacaine). Whether there is a difference between post-op analgesia durations, motor block formation, mobilization time and 90° flexion time between the groups will be investigated.
Detailed description
All patients scheduled for total knee arthroplasty will be evaluated before the operation. Eligible patients will be informed about the study and Numeric Rating Scale for pain evaluation. Then, patients will be asked for informed consent. After approval from the local research ethics committee, first patient will be recruited for study and patient's group will be determined by dice roll(1,4: GCont - 2,5: G125 - 3,6: G25). Patients who are scheduled for primary total knee arthroplasty under spinal anesthesia with a planned sensory block level between T4 and T7 dermatomes, will be recruited and assigned to a group. After successfully completed surgery, patients will be administered femoral nerve block or only dressing according to the relevant group. Before femoral nerve block is performed, patients will be re-informed about Numeric Rating Scale(NRS) and will be asked to rate their pain at the moment. * Control Group(GCont) patients will only be applied sterile dressing for the purpose of blinding the patient and the follow-up physician. * 0.125% Bupivacaine Group(G125) patients will be administered femoral block with 20 ml 0.125% Bupivacaine by an experienced anesthesiologist. * 0.25% Bupivacaine Group(G25) patients 10ml will be administered femoral block with 0.25% Bupivacaine by an experienced anesthesiologist. The procedures will be performed in the operating room under both US and nerve stimulator guidance. Patients will be followed-up in post-anesthesia care unit and in the ward for 48 hours. Scheduled and on-demand(Tramadol) medication for analgesia will be ordered and nurses will be informed about the study. Patients' pain scores and ambulation times will be followed-up by another anesthesiologist and on-demand medication will be recorded and monitored from hospital's computer based hospital management program online. Patients will be followed-up for six months after the surgery in order to explore potential long term benefits and complications.
Interventions
Femoral nerve block will be applied post-operatively with guidance of USG and nerve stimulator
OTHERDressing
Only dressing will be applied to related area to protect blindness between groups
Perineural Injection
DRUGBupivacaine 0.125% Injectable Solution
Perineural Injection
Sponsors
Bozyaka Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Intervention model description
Three groups involved. One control group and two nerve block groups with different drug concentration
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who are scheduled for primary unilateral total knee arthroplasty under spinal anesthesia * Patients who has informed consent for study
Exclusion criteria
* Patient's refusal to participate * Patients under 18 years of age * Patients who are undergoing surgery with an anesthesia technique other than spinal anesthesia for any reason (general anesthesia, laryngeal mask application, etc.) * Patients with known local anesthetic allergy * Patients with Body mass index \> 35 * Patients diagnosed sepsis and bacteriemia, * Skin infection at the injection site, * History of coagulopathy or anticoagulant therapy * Patients with uncontrolled diabetes , * Uncoordinated patients, * Psychological and emotional lability, * Surgical intervention longer than 3 hours. * Patients with pre-operative limitation of movement
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative pain assessed by Numeric Rating Scale (NRS) | 30th minute postoperatively | Pain scores will be recorded as reported by the patient according to NRS |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ambulation Time | 72 hours post-operatively | First time a patients can walk around independently |
| Opioid Consumption | 48 hour post-operatively | Opioids(Tramadol) will be administered to patients in case demanded. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Long Term Infection | Six months post-operatively | Surgery site or prosthesis infection in six months following surgery |
Countries
Turkey (Türkiye)
Outcome results
None listed