Total Knee Anthroplasty
Conditions
Keywords
Postoperative analgesia, total knee replacemenet, femoral nerve block, controlled study, prospective
Brief summary
Total knee arthroplasty (TKA) is a common orthopedic procedure in which effective postoperative pain management is important for early mobilization and rehabilitation. Various regional anesthesia techniques are used as part of multimodal analgesia protocols to improve postoperative pain control. Genicular nerve block has recently been introduced as a potential motor-sparing technique that may enhance postoperative analgesia when used alone or in combination with other regional blocks. The aim of this randomized controlled study is to evaluate whether the addition of ultrasound-guided genicular nerve block to femoral nerve block improves early postoperative analgesia in patients undergoing primary unilateral total knee arthroplasty under combined spinal-epidural anesthesia. A total of 80 patients aged 18-80 years scheduled for elective primary unilateral TKA will be included and randomly assigned to two groups using sealed envelopes. One group will receive femoral nerve block alone (Group F), while the other group will receive femoral nerve block combined with genicular nerve block (Group FG). Postoperative pain scores using the visual analog scale (VAS), epidural patient-controlled analgesia consumption during the first 24 hours, and the time to additional analgesic requirement will be recorded and compared between the groups.
Detailed description
The aim of this prospective, randomized controlled study is to evaluate whether the addition of an ultrasound-guided (USG) genicular nerve block (GNB) to a standard femoral nerve block (FNB) improves postoperative analgesia compared with FNB alone in patients undergoing primary unilateral total knee arthroplasty (TKA). All patients will undergo surgery under combined spinal-epidural anesthesia. After administration of the spinal block and placement of the epidural catheter, participants will be randomly assigned to one of two groups. Group F (Control): Participants will receive an ultrasound-guided femoral nerve block using 20 mL of 0.25% bupivacaine. Group FG (Intervention): Participants will receive an ultrasound-guided femoral nerve block (20 mL of 0.25% bupivacaine) combined with a four-point ultrasound-guided genicular nerve block targeting the superomedial, superolateral, inferomedial, and inferolateral genicular nerve branches. Each branch will receive 5 mL of 0.25% bupivacaine. Postoperative analgesia will be standardized in both groups using an epidural patient-controlled analgesia (PCA) device operating in bolus-only mode (5 mL bolus, 20-minute lockout interval) containing fentanyl (3 µg/mL) and bupivacaine (0.5 mg/mL). The primary outcome measure will be the total volume of epidural analgesic solution consumed during the first 24 hours after surgery. Secondary outcome measures will include postoperative pain intensity assessed using the Visual Analog Scale (VAS) at predefined time points (0, 2, 8, 12, and 24 hours), time to first additional analgesic requirement, and the incidence of postoperative side effects such as nausea or dizziness.
Interventions
Administration of 20 ml of 0.25% bupivacaine to the femoral nerve under ultrasound guidance. This procedure was performed on patients in both Group F and Group FG
PROCEDUREltrasound-guided Genicular Nerve Block
Administration of 5 ml of 0.25% bupivacaine to each of the four genicular nerve branches (superomedial, superolateral, inferomedial, and inferolateral) under ultrasound guidance. This procedure was performed only on patients in Group FG
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
Based on your source, you should select the roles that were blinded. If only the outcomes assessor or patients were blinded, check the relevant boxes.
Intervention model description
Participants were randomly assigned to two parallel groups. One group received ultrasound-guided femoral nerve block only (Group F), while the other group received a combination of femoral nerve block and genicular nerve block (Group FG). Postoperative pain scores and analgesic consumption were compared between the groups within the first 24 hours following total knee arthroplasty.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Patients aged ≥18 years Scheduled for elective total knee replacement surgery American Society of Anesthesiologists (ASA) physical status I-III Planned to receive femoral nerve block with or without genicular nerve block Ability to provide written informed consent
Exclusion criteria
Refusal to participate Contraindication to regional anesthesia Coagulopathy or ongoing anticoagulant therapy incompatible with nerve block Infection at the injection site Known allergy to local anesthetics Severe hepatic or renal insufficiency Cognitive impairment preventing pain assessment Chronic opioid use or opioid dependency
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Title: 24-hour postoperative epidural analgesic consumption.Description: The total dose (in ml) of epidural analgesic consumed by the patient via the patient-controlled analgesia (PCA) device within the first 24 hours following total knee arthroplasty su | First 24 hours following the total knee arthroplasty (TKA) procedure | Total volume (in ml) of the epidural analgesic solution (fentanyl and bupivacaine) consumed by the patient via the patient-controlled analgesia (PCA) device within the first 24 hours post-surgery. |
| 24-hour postoperative epidural analgesic consumption. | First 24 hours following the total knee arthroplasty (TKA) procedure. | Total volume (in ml) of epidural analgesic solution (fentanyl and bupivacaine) consumed by the patient via the patient-controlled analgesia (PCA) device within the first 24 hours post-surgery |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORSemih Baskan, Proffesor
Ankara City Hospital Bilkent
Outcome results
None listed