Efficacy of Combined Adductor and Tibial Nerve Blocks for Pain Management in Knee Arthroplasty
- Conditions
- Regional AnesthesiaPostoperative Pain ManagementTotal Knee ArthroplastyNerve Blocks
- Registration Number
- NCT06552897
- Lead Sponsor
- Ankara City Hospital Bilkent
- Brief Summary
This study aims to explore methods for enhancing pain relief following knee replacement surgery, a prevalent procedure for individuals with severe knee arthritis. Effective postoperative pain management is essential for ensuring a swift and comfortable recovery. Traditional pain management methods often involve medications that may have side effects; therefore, this study examines alternative approaches utilizing nerve blocks.
Two pain management methods are compared in this study:
Adductor Canal Block (ACB) Alone: A technique that numbs the anterior and medial regions of the knee.
Combined Adductor Canal Block and Selective Tibial Nerve Block (ACB + STNB): An innovative approach that includes an additional block to numb the posterior aspect of the knee.
The objective is to determine whether the combined approach offers superior pain relief, reduces the reliance on pain medications, and enhances overall postoperative recovery. Participants are randomly assigned to one of the two groups and receive the nerve blocks during their surgery.
This study aspires to contribute to the development of improved pain management strategies, facilitating quicker and more comfortable recovery for patients undergoing knee replacement surgery.
- Detailed Description
Total knee arthroplasty (TKA), or knee replacement surgery, is a highly effective treatment for severe knee arthritis, providing significant pain relief and improved joint function. However, managing postoperative pain remains a significant challenge. Effective pain control is essential for facilitating early mobilization, reducing complications, and enhancing overall recovery.
Traditional pain management often relies heavily on opioids, which can cause side effects such as nausea, dizziness, and dependency. To address these concerns, regional anesthesia techniques, including nerve blocks, are increasingly utilized to provide targeted pain relief while minimizing opioid use.
This study evaluates the effectiveness of two nerve block techniques in managing postoperative pain following TKA:
Adductor Canal Block (ACB): This technique targets nerves in the adductor canal, primarily affecting the saphenous nerve, which provides sensation to the anterior and medial regions of the knee. ACB is recognized for preserving muscle strength, thereby facilitating early mobility.
Combined Adductor Canal Block and Selective Tibial Nerve Block (ACB + STNB): This approach incorporates a tibial nerve block to address the posterior aspect of the knee, aiming to provide comprehensive pain relief to both the anterior and posterior regions of the knee.
The study is a prospective, randomized controlled trial involving 76 patients undergoing TKA at Health Sciences University Ankara City Hospital. Participants are randomly assigned to receive either the ACB alone or the combined ACB + STNB.
Objectives:
To assess the effectiveness of the combined ACB + STNB in reducing postoperative pain compared to ACB alone.
To evaluate the impact on opioid consumption and overall patient satisfaction. To monitor potential side effects and the time to first additional analgesic requirement.
Methods:
Pain is measured using the Visual Analog Scale (VAS) at multiple time points after surgery.
The study also records total analgesic consumption via patient-controlled analgesia (PCA).
Secondary outcomes include side effects and patient satisfaction scores. The findings of this study could influence future pain management strategies for knee replacement surgeries, potentially offering patients a safer and more effective method for managing postoperative pain with fewer side effects.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 76
Age: 18 to 80 years. ASA Classification: Patients classified as ASA I, II, or III. Surgical Procedure: Scheduled for primary unilateral total knee arthroplasty (TKA) under combined spinal-epidural anesthesia.
Informed Consent: Ability to understand and provide written informed consent for participation in the study.
ASA Classification: Patients classified as ASA IV or V. Surgical History: Revision TKA or any previous knee surgeries on the affected joint.
Medical Conditions:
Infection or neuropathy at the injection site. Coagulopathy or use of anticoagulant medications. Severe cardiac, hepatic, respiratory, or renal disease. Diagnosis of diabetic neuropathy. History of cerebrovascular accident with motor or sensory deficits. Neuropsychiatric disorders that affect cognition or communication.
Pain Management:
Inability to understand or use the Visual Analog Scale (VAS) for pain assessment.
Long-term use of analgesic therapy that could interfere with study assessments. Allergies: Known allergy to local anesthetics used in the study. Block Failure: Failed blocks or anesthesia issues prior to surgery.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Postoperative Pain Levels Pain levels will be assessed at 0, 1, 2, 8, 12, and 24 hours following the completion of the surgical procedure. The intensity of postoperative pain will be evaluated using the Visual Analog Scale (VAS), a widely used pain assessment tool.Measurement Details: The VAS is a 10-point scale where 0 represents "no pain" and 10 represents "the worst pain imaginable." Higher scores indicate greater pain intensity.
- Secondary Outcome Measures
Name Time Method Patient Satisfaction Assessed 24 hours post-surgery. Patient satisfaction regarding pain management and overall experience will be measured.
Measurement Details: Satisfaction will be assessed using a 5-point Likert scale, where 1 represents "very dissatisfied" and 5 represents "very satisfied." Higher scores indicate greater satisfaction.Total Analgesic Consumption Within the first 24 hours post-surgery. Pain levels will be assessed at 0, 1, 2, 8, 12, and 24 hours following the completion of the surgical procedure.
Time to First Additional Analgesic Request Within the first 24 hours post-surgery Description: The time elapsed from the end of surgery to the first request for additional analgesics will be recorded.
Measurement Details: The time (in minutes) from the completion of surgery until the first patient-initiated request for additional analgesia will be measured. A longer duration indicates better initial pain control.Incidence of Side Effects Within the first 24 hours post-surgery. Description: The incidence of side effects such as nausea, vomiting, and hypotension will be documented.
Measurement Details: The occurrence of these side effects will be recorded as a binary outcome (yes/no). Additionally, the severity of side effects will be assessed using standard clinical grading scales.
Trial Locations
- Locations (1)
Health Sciences University Ankara City Hospital
🇹🇷Etimesgut, Ankara, Turkey