Adductor Magnus Plain Injection for Sciatic Nerve Block
Conditions
Keywords
sciatic nerve block, Femoral nerve, Adductor magnus muscle, knee surgeries
Brief summary
the goal of this clinical trial is to compare the efficacy of adductor magnus muscle plane injection as an approach for sciatic nerve block to sub-gluteal approach in combination with femoral nerve blocks as perioperative analgesia in knee surgeries.
Interventions
PROCEDUREAMM Group: Adductor Magnus Muscle Plane approach + Femoral Nerve Blocks
In the supine position, the femoral nerve block will be conducted using a high-frequency ultrasound probe to identify the femoral nerve just below the fascia iliaca. After proper sterilization, the needle will be advanced in-plane to inject 15 ml bupivacaine 0.5% around the nerve. After performing the femoral nerve block, the adductor magnus muscle plane block will be performed using a low-frequency ultrasound probe positioned 6 cm distal to the inguinal crease to identify the sartorius muscle, femoral artery, femoral vein, and femoral nerve on the deep side of the sartorius muscle, the probe will be slide by about 2-2.5 cm distally, where we could identify the plane between the adductor magnus and the semimembranosus muscles, and after proper sterilization, the needle will be slowly advanced until the needle tip is close to the posterior surface of the AMM, 20 mL of bupivacaine 0.5% will be injected while observing fluid distribution under the posterior surface of the AMM, Then GA.
PROCEDURESG Group: Sciatic nerve block by sub-gluteal approach + Femoral nerve blocks
While the patient is in the supine position, the femoral nerve block will be conducted using a high-frequency ultrasound probe to identify a cross-sectional view of the femoral nerve just below the fascia iliaca. After proper sterilization, the needle will be advanced in-plane to inject 15 ml bupivacaine 0.5% around the nerve. the patient will be turned on their sides with the operative side uppermost and flexed, the sub-gluteal sciatic nerve will be identified using a low-frequency probe, and then the same needle will be advanced the in-plane to inject 20 ml bupivacaine 0.5% around the nerve., then GA will be conducted as the other group
Sponsors
Mohammed Gaber Saad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* ASA (American Society of Anaesthesiologists) Physical Status I-III. * Patients who consent to receive regional anesthesia.
Exclusion criteria
* Patients with a history of allergy to local anesthetics. * Pre-existing neurological deficits in the lower extremities. * Coagulopathy or anticoagulation therapy that cannot be safely discontinued. * Infection at the site of block injection. * Severe obesity (BMI \> 40). * Patients with contraindications to regional anesthesia. * peripheral neuropathy. * Psychiatric disorders and communication difficulties.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of sciatic sensory block | At 30 minutes after the block | It will be assessed by evaluating the sharp sensation with pinprick testing, and the presence or loss of cold-warm feeling as (2 for normal sensory perception, 1 for loss of cold-warm feeling, and 0 for loss of pinprick sensation) for ciatic in the sole of foot. |
| Assessment of sciatic motor block | At 30 minutes after the block | Sciatic block will be evaluated by the motion of the foot and ankle joint (3 for normal movement, 2 for unable to push or flex the foot against external resistance, 1 for unable to push or flex the foot against gravity and 0 for no motion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The duration of the sciatic nerve block procedure | during sciatic nerve block conduction | the time in minutes from the start of the sonographic examination for the sciatic nerve block until local anaesthetic administration. |
| Visibility scores for the sciatic nerve | during sciatic nerve block using sub gluteal approach conduction | using a 6-point visibility scale: 0: No nerve was identified 1. Nerve identified with a high probability 2. Nerve identified but most of it was not visible 3. Nerve identified and more than 50% of its borders were precisely distinguished from the surrounding structures 4. Nerve completely visible but fascicles poorly defined 5. Nerve completely visible and multiple fascicles identifiable |
| Postoperative pain scores | At 1, 6, 12, and 24 hours post-operative | Using the Visual Analog Scale (VAS) |
| Patient satisfaction | Before the patient discharge | Using 4 degrees scale: excellent, good, sufficient, insufficient |
| The onset of the Sciatic motor block | Every 3 minutes with maximum time 30 minutes (if no changes within 30 min the patient will be excluded from the study) | Time in minutes from removing of the local anesthesia needle to the start of motor changes |
| Visibility scores for Adductor magnus muscle (AMM) | during sciatic nerve block using adductor magnus muscle plain block conduction | using a 6-point visibility scale for AMM: 0: No muscle was identified 1. Muscle identified with a high probability 2. Muscle identified but most of it was not visible 3. Muscle identified and more than 50% of its epimysium were precisely distinguished from the surrounding structures 4. Muscle completely visible but perimysium poorly defined 5. Muscle completely visible and multiple perimysium identifiable |
| The onset of sciatic sensory blockades | Every 3 minutes with maximum time 30 minutes (if no changes within 30 min the patient will be excluded from the study) | Time in minutes from removing of the local anesthesia needle to the start of sensory changes |
Countries
Egypt
Outcome results
None listed