Total Knee Anthroplasty
Conditions
Keywords
Postoperative Analgesia, adductor canal block, erector spinae plane block, Total Knee Anthroplasty
Brief summary
Total knee arthroplasty (TKA) is a surgical procedure frequently associated with moderate-to-severe postoperative pain. While Adductor Canal Block (ACB) has demonstrated analgesic efficacy in TKA, the Erector Spinae Plane Block (ESPB) is also being utilized as part of multimodal analgesia for postoperative pain management in lower extremity surgeries. Currently, there is a gap in the literature as no studies have directly compared the efficacy of ACB and ESPB for pain management following TKA. The primary objective of this study is to compare the efficacy of these two analgesic methods in the context of postoperative analgesia management after total knee arthroplasty.
Detailed description
In our clinic, various regional blocks are applied for analgesia or anesthesia purposes in many surgeries, including knee surgery. For knee surgery, adductor canal block, lumbar epidural analgesia, genicular block, erector spinae plane block, and iPACK block can be used. In our clinic, erector spinae plane block and adductor canal block are routinely applied to knee surgery patients. In our study, we aimed to contribute to the literature by comparing patient satisfaction surveys and pain follow-up in patients undergoing knee arthroplasty who received adductor canal block versus lumbosacral erector spinae plane block, both applied with PROSPECT protocols for postoperative analgesia.
Interventions
After determining the L5-S1 level with ultrasound guidance, an 80 mm block needle (Stimuplex Ultra®, Braun, Melsungen, Germany) will be advanced in a cranio-caudal direction. Following hydrodissection, 30 ml of 0.25% bupivacaine local anesthetic solution containing 7.5 mcg of epinephrine (1:200,000) will be administered.
Sponsors
Emre ULUSOY
Bursa City Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
he patient and the outcomes assessor who performs postoperative pain evaluation will not know the group
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* patients who underwent total knee arthroplasty surgery * ASA I-II patients
Exclusion criteria
* Patient refusal to participate in the study * Patients with coagulopathy * Patients history with local anesthetic allergy or toxicity * Patients with liver and kidney failure * Mentally disabled patients * Presence of infection at the injection site * Pregnant, suspected pregnant, or breastfeeding mothers
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| opioid consumption | 0, 2, 4, 8, 16, 24 and 48 hours | Tramadol will be prepared as 5mg/ml and patient-controlled analgesia will be administered without basal infusion, with a locking time of 20 minutes and a bolus dose of 10mg. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain scores (Numerical rating scale) (0-meaning no pain to 10-meaning worst pain imaginable) | The NRS scores of the patients will be evaluated at the postoperative 0, 2, 4, 8, 16, 24 and 48 hours. | Postoperative 48 hours period. Patients' pain scores will be questioned at 0, 2, 4, 8, 16, 24 and 48 hours. |
| 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 48th hour. | Researchers will use the Turkish version of the Quality Improvement Survey/QoR-15. PART A: Participants will be asked by researchers how they felt 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 Participants will be asked by the researchers whether they have experienced 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 |
| Determine the time to first postoperative mobilization (The Timed Up and Go - TUG test): | The Timed Up and Go (TUG) test will be performed at the 20th minute after the preoperative block. | Place a chair in a location where walking can be observed. The area should be free of obstacles and interruptions. Measure a distance of 3 meters and draw a line on the floor at this distance. Use colored tape if available (to be clearly visible from the floor). Seat the patient in a chair, with access to their usual walking aid if applicable. Ask the patient to start and begin the timer. The patient stands up, walks past the 3-meter mark, turns, then walks back to the chair and sits down again. Record the time taken to complete the entire maneuver. |
Countries
Turkey (Türkiye)
Contacts
Primary ContactMursel Ekinci
Backup ContactEmre ULUSOY
Outcome results
None listed