Knee Osteoarthritis, Knee Injuries, Knee Disease, Knee Arthritis
Conditions
Keywords
Knee Surgery, Postoperative pain management, Postoperative Analgesia, Parasartorial compartment block
Brief summary
Selective blockade of the saphenous nerve branches is among the regional anesthesia techniques in knee surgery. In this block, analgesia is provided without motor block and is an essential advantage in terms of early mobilization in the postoperative period. Blockage of motor branches causes a delay in mobilization and increases the risk of falling. The vastus medialis and its medical femoral cutaneous branch are rich in the femoral triangle. Effective postoperative analgesia is provided by a femoral triangle (triangle) blockade. The intermediate femoral cutaneous nerve courses over the sartorius muscle. Anatomically, the femoral triangle follows a separate path. When the femoral triangle and the blockade of the intermediate femoral cutaneous nerve are combined, it is called PSKB block. Parasartorial compartment block (PSKB); is based on the blockade of the branches of the saphenous nerve, the two largest sensory nerves from the femoral nerve to the knee, and is predicted to provide effective postoperative analgesia in knee arthroplasty.
Detailed description
Selective blockade of the saphenous nerve branches is among the regional anesthesia techniques in knee surgery. In this block, analgesia is provided without motor block and is an essential advantage in terms of early mobilization in the postoperative period. Blockage of motor branches causes a delay in mobilization and increases the risk of falling. The vastus medialis and its medical femoral cutaneous branch are rich in the femoral triangle. Effective postoperative analgesia is provided by a femoral triangle (triangle) blockade. The intermediate femoral cutaneous nerve courses over the sartorius muscle. Anatomically, the femoral triangle follows a separate path. When the femoral triangle and the blockade of the intermediate femoral cutaneous nerve are combined, it is called PSKB block. Parasartorial compartment block (PSKB); is based on the blockade of the branches of the saphenous nerve, the two largest sensory nerves from the femoral nerve to the knee, and is predicted to provide adequate postoperative analgesia in knee arthroplasty. Pascarella et al. applied PSKB to a 58-year-old patient who underwent knee surgery under spinal anesthesia and had pain in the postoperative period and reported that the patient with a visual pain score of 9 decreased to 2 after the block. This study, it is aimed to evaluate the effectiveness of para-sartorial canal block for postoperative analgesia management in patients undergoing knee surgery. Our primary aim is to compare postoperative opioid consumption, and our secondary aim is to evaluate postoperative pain scores (Numerical rating scale-NRS), the presence of motor blockade, first postoperative mobilization time, and side effects (allergic reaction, nausea, vomiting, etc.) associated with opioid use.
Interventions
Intravenous 0.5 mg/kg tramadol and 400 mg ibuprofen will be administered to all patients 30 minutes before the end of the surgical procedure. In the postoperative period, patients will be administered ibuprofen iv 400 mg 3x1. Postoperative patient evaluation will be performed by another pain nurse who is unaware of the procedure. Patients in all groups will be attached to IV PCA containing 10 mcg/ml fentanyl, 10 mcg bolus without infusion dose, and 10 min lock time protocol. If the NRS score is ≥ 4, 0.5 mg kg-1 iv meperidine will be administered as a rescue analgesic.
Sponsors
Medipol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
The patient and the outcomes assessor who performs postoperative pain evaluation will not know the group.
Intervention model description
There are two models for this study. Parasartorial compartment block (PSCB) group, and control group.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients with ASA classification I-III, * Aged 18-75 years * Who will be scheduled for knee surgery under spinal anesthesia.
Exclusion criteria
* Patients who have a history of bleeding diathesis, * Take anticoagulant therapy, * History of chronic pain before surgery, * Multiple trauma, * Who cannot assess their pain, * Who have been operated under spinal anesthesia, * Who have an infection in the area and do not accept the procedure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain scores (Numerical Rating Scale-NRS) | Changes from baseline pain scores at postoperative 8th hour | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rescue analgesia (Opioid-tramadol consumption) | Changes from baseline opioid consumption at postoperative 1, 2, 4, 8, 16 and 24 hours. | The tramadol consumption as rescue analgesia will be evaluated |
| Adverse events will be recorded | Postoperative 24 hours period | Adverse events; nausea, vomiting, itching |
Countries
Turkey (Türkiye)
Outcome results
None listed