Femoral Triangle Block, Adductor Canal Block, Anterior Cruciate Ligament Reconstruction
Conditions
Brief summary
The aim of this study is to compare the postoperative analgesic effect of femoral triangle block (FTB) and adductor canal block (ACB)after arthroscopic anterior cruciate ligament (ACL) reconstruction.
Detailed description
The number of patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction has risen over the past decade. ACL reconstruction is associated with moderate to severe postoperative pain leading to hypertension, tachycardia, increased O2 demand, and myocardial stress.
Interventions
Patients will receive femoral triangle block (FTB) at the end of surgery. The probe will be positioned at the level where the medial border of the sartorius muscle intersects the medial border of the adductor longus muscle, a block needle advanced in an in-plane technique into femoral triangle. After negative aspiration, 2ml of saline will be injected to confirm the needle tip position close to the femoral artery then injection of 15ml of bupivacaine 0.25% will be performed.
OTHERAdductor Canal Block
Patients will receive adductor canal block (ACB) at the end of surgery. The probe will be positioned at the point midway between the anterior superior iliac spine and the upper pole of the patella. The adductor canal will be located as a hyperechoic structure beneath the Sartorius muscle and a block needle advanced in an in-plane technique toward the target nerve after negative aspiration, 2ml of saline will be injected into adductor canal to confirm the block needle tip within it, the block needle will be advanced with the guidance of ultrasound in an in-plane technique and 15ml bupivacaine 0.25% will be injected.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 21 to 65 years. * Both sexes. * American Society of Anesthesiologists (ASA) physical status I and II. * Undergoing elective arthroscopic Anterior Cruciate Ligament (ACL) reconstruction.
Exclusion criteria
* Revisional surgery. * Body mass index (BMI) \>35kg/m2. * Coagulopathy. * Infection at site of intervention. * Hypersensitive to the study drugs. * Chronic analgesic use. * Neuromuscular disease. * Drug abuse. * Cognitive impairment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Rescue analgesia of 3 mg morphine IV will be given if the Numeric Rating Scale (NRS) \> 3 to be repeated after 30 min if pain persists until the NRS \< 4. NRS will be assessed at 2, 4, 6, 12, and 24h postoperatively |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of 1st rescue analgesia | 24 hours postoperatively | Postoperatively, all patients will receive paracetamol 1gm/6h and diclofenac sodium 75mg I.M/12h as regular analgesia. Rescue analgesia of 3 mg morphine IV will be given if the Numeric Rating Scale (NRS) \> 3 to be repeated after 30 min if pain persists until the NRS \< 4. NRS will be assessed at 2, 4, 6, 12, and 24h postoperatively. |
| Pain score using Numeric Rating Scale (NRS) | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) (0 represents no pain while 10 represents the worst pain imaginable). It will be assessed at 2, 4, 6, 12, and 24h postoperatively. |
| Quadriceps strength | 24 hours postoperatively | Quadriceps strength will be assessed at 2, 4, 6, 12, and 24h postoperatively. The criteria for evaluation of quadriceps strength are as follow: I (no contraction), II (have contraction, but cannot move joint), III (can move joint, but cannot resist gravity), IV (can resist gravity, but cannot bear substantial resistance), V (can bear a certain intensity of resistance), and VI (can bear full resistance). |
| Patient satisfaction | 24 hours postoperatively | Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied) |
Countries
Egypt
Outcome results
None listed