Presurgical Adductor Canal Block (ACB) Versus ACB and Distal (Intermuscular) Saphenous Nerve Block in Patients Undergoing Anterior Cruciate Ligament Repair Under General Anaesthesia: Randomised Controlled Trial.
Overview
- Phase
- Not Applicable
- Intervention
- Ultrasound Guided Adductor Canal Block
- Conditions
- Postoperative Pain
- Sponsor
- Cairo University
- Enrollment
- 88
- Locations
- 1
- Primary Endpoint
- The total dose of morphine consumption in the first 24 hours postoperatively.
- Last Updated
- 5 years ago
Overview
Brief Summary
Knee surgeries are associated with severe postoperative pain. Blocking the femoral nerve (or saphenous nerve) in the adductor canal is increasingly used for knee analgesia. It carries potential benefits that encourage anesthesiologists to do it. It has a motor sparing property. Injection of local anesthetics in this lengthy canal that contains a variable amount of connective or fibrous tissue might lead to a patchy distribution of local anesthetics. Thus, the possibility of incomplete block of the saphenous nerve (most important nerve in knee innervations) cannot be excluded.
Detailed Description
Aim of the study is to compare the efficacy of the adductor canal block to the combined adductor canal block and saphenous nerve block at the distal third of thigh in the intermuscular plane between Vastus Medialis and Sartorius muscles in pain relief following knee arthroscopic anterior cruciate ligament repair. After written informed consent, patients will be randomized in three groups: Group (Adductor 20): Ultrasound guided adductor canal block will be performed with injection of 20 ml bupivcaine 0.5%. Group (Adductor 30) Ultrasound guided adductor canal block will be performed with injection of 30 ml bupivacaine 0.5%. Group (Adductor/saphenous ): Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine 0.5%, combined with ultrasound guided saphenous
Investigators
Bassant M. Abdelhamid
associate professor
Cairo University
Eligibility Criteria
Inclusion Criteria
- •Scheduled for knee orthopedic ( ACL repair)
- •Physical status ASA I, II.
- •Body mass index (BMI): \> 20 kg/m2 and \< 35 kg/m2.
Exclusion Criteria
- •• Patients with known sensitivity or contraindication to drug used in the study (local anesthetics, opioids).
- •History of psychological disorders and/or chronic pain.
- •Contraindication to regional anesthesia e.g. local sepsis, pre- existing peripheral neuropathies and coagulopathy.
- •Infection of the skin at the site of needle puncture area.
- •Patient refusal.
- •Severe respiratory or cardiac disorders.
- •Advanced liver or kidney disease.
- •Pregnancy.
- •Patient with surgery duration more than two hours.
Arms & Interventions
Adductor 20
Ultrasound guided adductor canal block will be performed with injection of 20 ml bupivacaine
Intervention: Ultrasound Guided Adductor Canal Block
Adductor 20
Ultrasound guided adductor canal block will be performed with injection of 20 ml bupivacaine
Intervention: General anesthesia
Adductor 20
Ultrasound guided adductor canal block will be performed with injection of 20 ml bupivacaine
Intervention: Bupivacaine 20 ml
Adductor 30
Ultrasound guided adductor canal block will be performed with injection of 30ml bupivacaine
Intervention: Ultrasound Guided Adductor Canal Block
Adductor 30
Ultrasound guided adductor canal block will be performed with injection of 30ml bupivacaine
Intervention: General anesthesia
Adductor 30
Ultrasound guided adductor canal block will be performed with injection of 30ml bupivacaine
Intervention: Bupivacaine 30ml
Adductor /Saphenous
Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine , combined with ultrasound guided saphenous nerve block at the distal third of the thigh in the intermuscular plane between Vastus Medialis and Sartorius muscle with injection of 10ml bupivacaine 0.5%.
Intervention: Ultrasound Guided Adductor Canal Block
Adductor /Saphenous
Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine , combined with ultrasound guided saphenous nerve block at the distal third of the thigh in the intermuscular plane between Vastus Medialis and Sartorius muscle with injection of 10ml bupivacaine 0.5%.
Intervention: Ultrasound Guided Saphenous Nerve Block
Adductor /Saphenous
Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine , combined with ultrasound guided saphenous nerve block at the distal third of the thigh in the intermuscular plane between Vastus Medialis and Sartorius muscle with injection of 10ml bupivacaine 0.5%.
Intervention: General anesthesia
Adductor /Saphenous
Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine , combined with ultrasound guided saphenous nerve block at the distal third of the thigh in the intermuscular plane between Vastus Medialis and Sartorius muscle with injection of 10ml bupivacaine 0.5%.
Intervention: Bupivacaine 20 ml
Adductor /Saphenous
Ultrasound guided adductor canal block will be performed by injection of 20 ml bupivacaine , combined with ultrasound guided saphenous nerve block at the distal third of the thigh in the intermuscular plane between Vastus Medialis and Sartorius muscle with injection of 10ml bupivacaine 0.5%.
Intervention: Bupivacaine 10ml
Outcomes
Primary Outcomes
The total dose of morphine consumption in the first 24 hours postoperatively.
Time Frame: 24 hours postoperative
The total amount of morphine consumption in the first 24 hours postoperatively.
Secondary Outcomes
- Failure rate of the block(24 hours)
- Block related complications(1 mounth)
- Total dose of intraoperative fentanyle adminstration(2 hours intraoperatively)
- Numeric Pain Rating Scale(24 hours postoperative)