Anterior Cruciate Ligament Injury
Conditions
Keywords
Anterior Cruciate Ligament Reconstruction, Adductor Canal Block, Vastus Medialis Nerve Block, Regional Anesthesia, Postoperative Pain
Brief summary
Anterior cruciate ligament (ACL) reconstruction is frequently associated with moderate to severe postoperative pain, which can delay mobilization and rehabilitation. The adductor canal block (ACB) is widely used for postoperative pain management because it provides effective analgesia while preserving quadriceps muscle strength. However, pain originating from the medial aspect of the knee may not be adequately controlled with ACB alone because the nerve to the vastus medialis may not be consistently anesthetized. This prospective randomized controlled trial evaluates whether adding a vastus medialis nerve block (VMNB) to a standard adductor canal block improves postoperative pain control in patients undergoing elective arthroscopic ACL reconstruction. Participants are randomly assigned to receive either ACB alone or ACB combined with VMNB before surgery, while all patients receive the same standardized general anesthesia, surgical technique, and postoperative analgesic regimen. The primary outcome is postoperative pain intensity measured using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours after surgery. Secondary outcomes include postoperative opioid consumption, time to first mobilization, length of hospital stay, and block-related complications. The results of this study may help determine whether the addition of a vastus medialis nerve block provides clinically meaningful benefits and may contribute to improving postoperative pain management following ACL reconstruction.
Interventions
PROCEDUREAdductor Canal Block (ACB) Only
An ultrasound-guided adductor canal block was performed before induction of general anesthesia using 15-20 mL of 0.25% bupivacaine as part of the multimodal analgesia protocol for anterior cruciate ligament reconstruction.
PROCEDUREVastus Medialis Nerve Block
An ultrasound-guided vastus medialis nerve block was performed before induction of general anesthesia using 5-10 mL of 0.25% bupivacaine in addition to the adductor canal block.
Sponsors
Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Intervention model description
Participants were randomly assigned in a 1:1 ratio to receive either an adductor canal block alone or an adductor canal block combined with a vastus medialis nerve block before elective arthroscopic anterior cruciate ligament reconstruction. Both groups received standardized general anesthesia, perioperative care, and postoperative analgesic management.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 to 65 years. * Scheduled for elective primary arthroscopic anterior cruciate ligament (ACL) reconstruction. * American Society of Anesthesiologists (ASA) physical status I or II. * Ability to provide written informed consent.
Exclusion criteria
* Previous surgery on the ipsilateral knee. * Bilateral knee surgery. * Coagulopathy or ongoing anticoagulant therapy contraindicating regional anesthesia. * Peripheral neuropathy or neuromuscular disease. * Local infection at the block injection site. * Known allergy or hypersensitivity to amide local anesthetics. * Contraindication to regional anesthesia. * Refusal to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity | 24 hours after surgery | Postoperative pain intensity will be assessed using the 10-cm Visual Analog Scale (VAS) at rest at 1, 6, 12, and 24 hours after surgery. VAS scores range from 0 (no pain) to 10 (worst imaginable pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Opioid Consumption | 24 hours after surgery | Total opioid consumption during the first 24 postoperative hours will be calculated as intravenous morphine equivalent dose (mg). |
| Time to First Mobilization | 24 hours after surgery | Time from completion of surgery to the patient's first successful ambulation, recorded in hours. |
| Length of Hospital Stay | 24 hours after surgery | Length of postoperative hospital stay measured in hours from the end of surgery until hospital discharge. |
Countries
Turkey (Türkiye)
Outcome results
None listed