A Tale of Two Blocks: Comparing Adductor Canal and Dual Subsartorial techniques in Total Knee Replacement.

A Tale of Two Blocks: Comparing Adductor Canal and Dual Subsartorial Techniques in Total Knee Replacement will be a prospective randomized controlled trial to evaluate postoperative analgesia and motor performance in patients undergoing total knee replacement (TKR), which often causes significant pain impeding mobility and recovery. Peripheral nerve blocks like Adductor Canal Block (ACB) and Dual Subsartorial Block (DSB) provide targeted relief while preserving motor function, and this study will compare their efficacy. The primary aim will be to assess differences in analgesia and motor function, with objectives measuring analgesia duration, total rescue analgesic dose in the first 24 hours, VAS scores at 2, 4, 6, 12, and 24 hours postoperatively, and motor performance with knee range of motion. Secondary objectives will analyze complications from ACB, DSB, and post-anesthesia care, plus drug side effects.

 The study will be conducted at MMI Narayana Multi-Speciality Hospital in Raipur, Chhattisgarh, over 24 months post-IEC and CTRI approval, including ASA I-II patients aged 18-75 scheduled for TKR, excluding those under 18 or over 75, ASA III-IV, with infections, pregnancy, lactation, psychological/neurological/coagulation issues, or drug allergies. Preoperative tests will include CBC, PT/INR, blood sugar, electrolytes, ECG, chest X-ray, and liver/kidney function. After informed consent, patients will be randomized into ACB or DSB groups, premedicated with pantoprazole 40 mg and alprazolam 0.25 mg nightly, receiving subarachnoid block with 3.4 ml 0.5% hyperbaric bupivacaine. Postoperative ultrasound-guided blocks will use 35 ml 0.25% bupivacaine (17.5 ml 0.5% bupivacaine + 17.5 ml sterile water), monitoring vitals, VAS, motor function, and complications for 24 hours with rescue analgesia as needed.

 Sample size will be 60 (30/group), calculated at 99% CI and power from prior data (DSB analgesia: 6.155±0.898 vs. 4.833±0.791), adding 10 for attrition. Data in MS Excel will be analyzed via SPSS 21.0 using t-tests/Mann-Whitney U for continuous variables, Chi-square/Fisher exact for categorical, with p<0.05 significant.