Knee Osteoarthritis, Total Knee Arthroplasty, Postoperative Pain, Peripheral Nerve Block, Adductor Canal Block
Conditions
Brief summary
This study aims to compare the analgesic efficacy of surgeon-performed intraoperative adductor canal block (ACB) and ultrasound-guided anesthesiologist-performed ACB in patients undergoing bilateral total knee arthroplasty (TKA). In a prospective, randomized paired design, each patient will receive surgeon-performed ACB on one knee and anesthesiologist-performed ACB on the contralateral knee. The primary outcome is postoperative pain measured using the Numeric Rating Scale (NRS), and the study is designed to evaluate the non-inferiority of surgeon-performed ACB. Secondary outcomes include opioid consumption, time to first ambulation, length of hospital stay, postoperative complications, and patient-reported outcome measures (PROMs). Additionally, postoperative ultrasound evaluation will be performed to assess the distribution pattern of local anesthetic within the adductor canal, including cross-sectional area and longitudinal spread. This study is expected to provide evidence regarding the clinical effectiveness and technical accuracy of surgeon-performed ACB in comparison with the conventional ultrasound-guided technique.
Interventions
BIOLOGICALSurgeon-Performed Adductor Canal Block
An adductor canal block performed intraoperatively by the surgeon using an anatomical landmark-based technique. The injection is administered at approximately 8 cm proximal to the distal femur, with the needle directed medially and posteriorly. A total of 20 mL of 0.3% ropivacaine mixed with epinephrine is injected using a standardized approach without ultrasound guidance.
BIOLOGICALUltrasound-Guided Adductor Canal Block
An adductor canal block performed by an anesthesiologist under ultrasound guidance. The saphenous nerve and femoral artery within the adductor canal are identified using real-time imaging, and 20 mL of 0.3% ropivacaine mixed with epinephrine is injected using an in-plane technique.
Sponsors
Yonsei University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients aged 19 years or older * Patients scheduled for bilateral total knee arthroplasty * Patients who provide written informed consent
Exclusion criteria
* Refusal to participate or inability to provide informed consent * Neurological or psychiatric conditions affecting cooperation (e.g., dementia, delirium) * Pre-existing neurological or anatomical abnormalities of the lower extremities * Chronic opioid use or opioid dependence * Coagulation disorders or contraindications to nerve block * Pregnancy * Cases in which ultrasound evaluation is technically not feasible
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain (Numeric Rating Scale) | Baseline, postoperative day 0 (afternoon), postoperative day 1 (morning and afternoon), and postoperative day 2 (morning) | Postoperative pain will be assessed using the Numeric Rating Scale (NRS, 0-10). Pain scores will be recorded at predefined time points under resting conditions. The primary analysis will evaluate the non-inferiority of surgeon-performed adductor canal block compared to ultrasound-guided adductor canal block. |
Contacts
CONTACTKwan-Kyu Park, Professor
Outcome results
None listed