Total Knee Arthroplasty for Gonarthrosis
Conditions
Keywords
adductor canal block, Opioid consumption, Postoperative analgesia, Total knee arthroplasty
Brief summary
The biggest fear for patients undergoing knee replacement surgery is that persistent pain felt at the back of the knee postoperatively. While regional anesthesia is generally successful at numbing the front of the knee, managing pain in the posterior (back) area is not always easy. In this study, we tested a new method designed to alleviate pain in the back of the knee and improve patient comfort.
Detailed description
A New Solution for "Posterior" Pain After Knee Surgery To ensure patient comfort following knee replacement surgery, we routinely use ultrasound-guided injections of local anesthetics around the nerves of the knee to block pain signals. While this method is highly successful at eliminating pain in the anterior (front) part of the knee, studies have shown that the medication often fails to reach the deep posterior (back) compartments, leaving patients with persistent discomfort in that area. In this study, we addressed a fundamental question: "How can we ensure the medication reaches those hard-to-access depths at the very back of the knee?" To achieve this, we developed a simple yet highly effective technique. We applied a tourniquet-similar to a blood pressure cuff-to the upper leg and inflated it for a short period. We administered the medication, then released the tourniquet and performed a second application. This controlled pressure on the upper leg acted as a barrier, preventing the anesthetic from migrating upward toward the groin and instead "pushing" it into the narrow passages at the back of the knee. By doing so, we enabled the medication to reach deep points that it typically cannot access on its own. The Results: As a result of this technique, we observed a significant reduction in stubborn posterior knee pain. Furthermore, our patients required substantially fewer potent painkillers (analgesics) during their recovery.
Interventions
PROCEDURETourniquet-Assisted Adductor Canal Block (T-ACB) grou
Participants received an ultrasound-guided distal adductor canal block. The procedure was performed in two stages: First, a pneumatic tourniquet placed on the proximal thigh was inflated for 3-5 minutes (at a pressure of approximately 142-202 mmHg), during which 20 mL of 0.25% bupivacaine was injected. Subsequently, the tourniquet was deflated, and an additional 20 mL of 0.25% bupivacaine was administered, reaching a total volume of 40 mL. This technique aimed to enhance the distribution of the local anesthetic through the adductor hiatus to the popliteal plexus at the posterior aspect of the knee.
PROCEDUREStandard Adductor Canal Block (S-ACB)
Participants received a standard ultrasound-guided distal adductor canal block. During the procedure, 20 mL of 0.25% bupivacaine was injected in a single dose without any tourniquet modification or additional pressure application. The technique relied on the natural, passive, and anatomical distribution of the local anesthetic within the adductor canal.
Sponsors
Ankara Etlik City Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Masking description
Patients' relatives helped them describe their pain
Intervention model description
"The control group consisted of patients who underwent the routine adductor canal block, whereas the tourniquet group included patients who received the block with the application of a tourniquet."
Eligibility
Sex/Gender
ALL
Age
40 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Patients aged 40-85 years, with a BMI of 18-35 kg/m², and an ASA physical status of I-III who underwent total knee arthroplasty (TKA) under spinal anesthesia were included. Eligible participants were those who volunteered to participate and provided written informed consent.
Exclusion criteria
To ensure methodological standardization, the following cases were excluded: Patients undergoing revision surgery. Those undergoing unicompartmental (unicondylar) knee replacement, as the severity of surgical trauma differs from total replacement. Bilateral cases, to prevent potential bias in assessing postoperative opioid consumption and pain scores. Additionally, patients were excluded if: The surgical duration exceeded 180 minutes. There was a known history of coagulopathy, peripheral neuropathy, or allergy to local anesthetics. The spinal anesthesia was insufficient, requiring a conversion to general anesthesia.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| This method aims to alleviate posterior knee pain and decrease overall VAS scores | At 3, 8, 12, and 24 hours post-block | Visual Analog Scale (VAS): A scale where patients rate their pain intensity from 0 (no pain) to 10 (unbearable pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To decrease cumulative opioid requirements and facilitate mobilization while preserving muscle strength | at 3,8,12,24. post-block hours | 1. Total Opioid Consumption Total Opioid Consumption (The total amount of morphine/tramadol required during the first 24 hours postoperatively). 2. Preservation of Motor Function Preservation of Motor Function (Assessment of quadriceps muscle strength using the Bromage Scale). 3. Time to First Mobilization Time to First Mobilization (The hour at which the patient first stood up or ambulated postoperatively). |
Countries
Turkey (Türkiye)
Outcome results
None listed