Knee Arthropathy, Knee Disease, Knee Osteoarthritis
Conditions
Keywords
Total Knee Arthroplasty, Postoperative Analgesia Management, Adductor Canal Block, Perıcapsular Nerve Group Block
Brief summary
Knee arthroplasty surgery numbers are increasing depending on joint deformities and cartilage degenerations. Severe postoperative pain may occur in these patients due to surgery and the placed prosthesis. The aim of study is to compare the effectiveness of AKB and PENG block for postoperative analgesia management after knee arthroplasty.
Detailed description
Knee arthroplasty surgery numbers are increasing depending on joint deformities and cartilage degenerations. Severe postoperative pain may occur in these patients due to surgery and the placed prosthesis. Postoperative analgesia is important for early mobilization. So that, early movement of the joint is ensured and complications such as thromboembolism and infection are prevented. Various methods can be used for postoperative analgesia. One of these methods is epidural analgesia. However, it may not be applied due to the patient's refusal or the technical difficulties in the application. Another option is opioid agents. However; opioids have side effects such as nausea, vomiting, sedation, respiratory depression. Femoral nerve blockade can be done, but it is not preferred because it may prevent mobilization as a result of motor blockade. Current regional anesthesia techniques used in knee surgery include selective blockade of the saphenous nerve in the adductor canal (adductor canal block-ACB) and pericapsular nerve group block (PENG). Adductor canal block; affects the vastus medialis branch of the saphenous nerve, one of the two largest sensory nerves from the femoral nerve to the knee, and the articular branches of the obturator nerve. Since the block is made in the distal thigh, the innervation of the quadriceps muscle is not affected, and therefore the motor power of this muscle is largely preserved. Another lower extremity peripheral regional blockade technique that is gaining importance today is PENG block. PENG, which is a musculofacial plane block made between the tendon of the psoas muscle and the ramus pubis, provides block of the femoral nerve, obturator nerve and accessory obturator nerve. In both block methods, pure sensory blockade provides analgesia without quadriceps muscle weakness, and this provides a significant advantage in terms of early mobilization. The aim of this study is to compare these two analgesic methods in terms of effectiveness for postoperative analgesia management after knee arthroplasty. The primary outcome is to compare global recovery scores (QoR-15 scale), the secondary outcome is to compare postoperative pain scores (NRS), to evaluate postoperative opioid consumption, postoperative rescue analgesic (opioid) use, presence of motor blockade, postoperative first mobilization time, and side effects (allergic reaction, nausea, vomiting) associated with opioid use in this study.
Interventions
DRUGAdductor canal block
A linear ultrasound probe will be placed medial to the patella, the probe will be advanced to cephalad, and the superficial femoral artery will be visualized. The block site will be confirmed by injecting 5 ml of saline around the saphenous nerve in the subsartorial region under ultrasound guidance. Then, 30 ml of local anesthetic solution containing 0.25% bupivacaine (Marcain 0.5% AstraZeneca, England) will be administered.
DRUGPENG block
The probe will be placed at the anterior superior level of spina iliaca, parallel to the inguinal ligament. The probe will be scanned gradually towards the caudal. After the anterior inferior of the spina iliaca is visible, the probe will be slightly turned medially until the hyperechoic shadow of the superior pubic ramus is visible. The psoas muscle tendon will be visualized above the superior pubic ramus, then 5 ml of saline will be injected under the psoas tendon and the block location will be confirmed. After that 30 ml of 0.25% bupivacaine will be administered.
Sponsors
Bursa City Hospital
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. Adductor canal block group, and pericapsular nerve group block group
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) classification I-II * Scheduled for total knee arthroplasty under spinal anesthesia
Exclusion criteria
* history of bleeding diathesis * receiving anticoagulant treatment, * known local anesthetics and opioid allergy, * infection of the skin at the site of the needle puncture, * pregnancy or lactation, * patients who do not accept the procedur
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Global recovery scoring system (patient satisfaction scale) | The quality of recovery will be evaluated out of a total of 150 points according to the QoR-15 test to be applied at the portoperative 24th hour. | The investigators will use the Turkish version of Quality of Recovery / QoR-15 questionairre PART A How have you been feeling in the last 24 hours? (0 to 10, where: 0 = none of the time \[poor\] and 10 = all of the time \[excellent\]) 1. Able to breathe easily 2. Been able to enjoy food 3. Feeling rested 4. Have had a good sleep 5. Able to look after personal toilet and hygiene unaided 6. Able to communicate with 7. Getting support from hospital doctors and nurses 8. Able to return to work or usual home activities 9. Feeling comfortable and in control 10. Having a feeling of general well-being PART B Have you had any of the following in the last 24 hours? (10 to 0, where: 10 = none of the time \[excellent\] and 0 = all of the time \[poor\]) 11. Moderate pain 12. Severe pain 13. Nausea or vomiting 14. Feeling worried or anxious 15. Feeling sad or depressed |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain scores (Numerical rating scale) (0-meaning "no pain" to 10-meaning "worst pain imaginable") | Patients will be evaluated at the first 24 hours period postoperatively. | Postoperative 24 hours period. Patients' pain scores will be questioned at 0, 2, 4, 8, 16 and 24 hours. |
| The use of rescue analgesia | Meperidine consumption will be recorded at the first 24 hours period postoperatively. | The need for rescue analgesia will be recorded at the first 24 hours period postoperatively. |
Countries
Turkey (Türkiye)
Outcome results
None listed