Osteoarthritis, Knee
Conditions
Keywords
Adductor Canal Block, Local Infiltration Analgesia, Total Knee Arthroplasty, Postoperative Pain, Multimodal Analgesia, NRS, Hemodynamic
Brief summary
Total knee arthroplasty (TKA) is commonly associated with significant postoperative pain, which may impair early mobilization and functional recovery. Multimodal analgesia techniques are widely used to improve postoperative pain control while minimizing opioid consumption. Local infiltration analgesia (LIA) is a commonly used method; however, its effectiveness may be limited when used alone. The adductor canal block (ACB) provides effective analgesia while preserving quadriceps muscle strength. This prospective randomized controlled study aims to compare the effectiveness of adductor canal block combined with local infiltration analgesia versus local infiltration analgesia alone on postoperative pain scores in patients undergoing total knee arthroplasty. The primary outcome is postoperative pain assessed using the NRS at multiple time points within the first 48 hours. Secondary outcomes include opioid consumption, functional recovery parameters and hemodynamic parameters. The results of this study are expected to contribute to optimizing postoperative analgesia strategies in total knee arthroplasty.
Detailed description
Total knee arthroplasty (TKA) is frequently associated with moderate to severe postoperative pain, which can negatively affect early mobilization, rehabilitation, and patient satisfaction. Effective pain management strategies are essential for enhanced recovery protocols. Multimodal analgesia has become the standard approach, combining different techniques to improve analgesic efficacy while reducing opioid-related side effects. Local infiltration analgesia (LIA) is widely used as part of multimodal analgesia; however, it may not always provide sufficient analgesia when used alone. The adductor canal block (ACB) has gained popularity due to its ability to provide sensory blockade of the saphenous nerve while preserving quadriceps muscle strength, thus facilitating early mobilization. This prospective randomized controlled trial was conducted to evaluate the effect of combining ACB with LIA compared to LIA alone in patients undergoing total knee arthroplasty. Patients were randomly assigned into two groups: one group received ACB combined with LIA, while the control group received LIA alone. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 2, 6, 12, 24 and 48 hours postoperatively. Secondary outcomes included total opioid consumption and functional recovery parameters. Demographic data, operative variables, and perioperative characteristics were also recorded and analyzed. The findings of this study aim to provide evidence regarding the efficacy of combining regional anesthesia techniques with local infiltration analgesia in improving postoperative pain control following total knee arthroplasty.
Interventions
PROCEDUREAdductor Canal block
Ultrasound-guided adductor canal block was performed using local anesthetic to provide postoperative analgesia.
PROCEDURELocal Infiltration Analgesia
Local infiltration analgesia was administered intraoperatively using local anesthetic agents around the surgical site.
Sponsors
Ankara University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 years and older * Patients scheduled for elective total knee arthroplasty * American Society of Anesthesiologists (ASA) physical status I-III * Patients who provided written informed consent
Exclusion criteria
* Known allergy to local anesthetics * Coagulation disorders or anticoagulant therapy contraindicating regional anesthesia * Infection at the injection site * Severe hepatic or renal dysfunction * Neurological disorders affecting lower extremities * Cognitive impairment preventing pain assessment * Refusal to participate * Body mass index (BMI) greater than 30 kg/m²
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain at rest (Numerating Rating Scale, NRS) | 2,6,12,24,48 | Postoperative pain was assessed using the NRS at rest at predefined time points. Postoperative pain was assessed using the Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Pain scores were recorded at rest at predefined time points. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opioid Consumption | 0-48 hours postoperatively | Total opioid consumption within the first 48 hours postoperatively. |
| Knee flexion range of motion (degrees) measured with a goniometer | 24 and 48 hours postoperatively | Functional recovery will be assessed by measuring knee flexion range of motion (degrees) using a standard goniometer at predefined postoperative time points. |
| Heart rate (beats per minute) | Baseline (preoperative) and every 15 minutes from induction of anesthesia to extubation | Heart rate (beats per minute) will be recorded at baseline and at 15-minute intervals from induction of anesthesia to extubation. |
| Mean arterial pressure (mmHg) | Baseline (before induction of anesthesia) and every 15 minutes from induction of anesthesia to extubation | Mean arterial pressure (mmHg) will be recorded at baseline (preoperative) and at 15-minute intervals during the intraoperative period. |
Countries
Turkey (Türkiye)
Outcome results
None listed