Arthroplasty, Knee Osteoarthritis
Conditions
Keywords
Suprainguinal Fascia Iliaca Block, Adductor Canal Block, Ultrasound-Guided Nerve Block, Regional Anesthesia
Brief summary
This study evaluates the analgesic efficacy and motor-sparing properties of ultrasound-guided Suprainguinal Fascia Iliaca Block (S-FIB) compared with Adductor Canal Block (ACB) in patients undergoing primary total knee arthroplasty (TKA). The main hypothesis is that ACB better preserves quadriceps muscle strength, allowing earlier functional mobilization, while providing comparable (non-inferior) analgesia to S-FIB.
Detailed description
Total knee arthroplasty is associated with severe postoperative pain requiring effective multimodal analgesia, and regional nerve blocks are integral to Fast-Track / ERAS (Enhanced Recovery After Surgery ) protocols. The Suprainguinal Fascia Iliaca Block (S-FIB) targets the anterior branches of the lumbar plexus (femoral, lateral femoral cutaneous, and obturator nerves) from a single high-volume injection, but proximal femoral spread can produce quadriceps motor weakness. The Adductor Canal Block (ACB) predominantly blocks the saphenous nerve, sparing motor function at the potential expense of less comprehensive analgesia.
Interventions
DRUGPCA
All patients receive standardized spinal anesthesia and postoperative intravenous PCA tramadol within a standardized multimodal regimen.
Sponsors
Bursa Yuksek Ihtisas Training and Research Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
45 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* ASA Physical Status I, II, or III * Scheduled for elective unilateral primary total knee arthroplasty * Able to understand and operate the PCA device * Written informed consent provided
Exclusion criteria
* Pre-existing lower-extremity neurological deficit or motor weakness (e.g., severe diabetic neuropathy) * Chronic opioid use (\>30 mg oral morphine equivalents/day for \>3 months) * Infection at the block site or systemic sepsis * Coagulopathy or bleeding diathesis * Allergy to local anesthetics or study medications * Revision TKA or bilateral knee procedures * Cognitive impairment or inability to perform mobility/pain assessments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity (NRS) | Postoperative hours 24 hour | Numerical Rating Scale (0-10) at rest and during active knee flexion (30°). Time Frame: Postoperative hours 2, 6, 12, 24, and 48. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quadriceps Muscle Strength | Postoperative hours 6 and 12. | Active Straight Leg Raise (SLR) Angle Maximum hip flexion angle (degrees, 0-90°) achieved during an active straight leg raise in the supine position, measured with a digital clinometer/goniometer. |
| Cumulative Opioid Consumption | 24 and 48 hours postoperatively. | Total IV tramadol delivered via PCA (patient controlled analgesia). |
| Time to First Mobilization | Up to 48 hours postoperatively. | Hours from end of surgery to first assisted/unassisted ambulation |
| Quality of Recovery (QoR-15) | Baseline (preoperative) and 24 hours postoperatively. | Validated 15-item questionnaire (0-150; higher = better recovery). |
Contacts
CONTACTKorgün Ökmen
PRINCIPAL_INVESTIGATORKorgün Ökmen, PhD.MD
University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Anesthesiology and Reanimation
Outcome results
None listed