Comparison of different doses of Butorphanol as adjuvant with Ropivacaine for single shot Adductor canal block in knee Arthroscopic surgery

AIMS AND OBJECTIVES

1- To evaluate the post operative analgesic efficacy of two different doses of butorphanol using NRS pain scoring system in USG guided adductor canal block in knee arthroscopic surgery .

2- To compare total post operative analgesic consumption among the three groups.

3- To compare the incidence of adverse effects and complications if any.

4-To evaluate patient satisfaction using QR15 score .

BRIEF SUMMARY

Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and  treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed during ACL reconstruction. This reduces recovery time and may increase the rate of success due to less trauma to the connective tissue. It has gained popularity due to evidence of faster recovery times with less scarring, because of the smaller incisions.

Arthroscopic knee  surgery is accompanied with considerable postoperative pain. Early postoperative mobilization and rehabilitation require adequate pain management of the patient . Despite the fact that femoral nerve block (FNB) or continuous epidural anesthesia (CEA) can provide adequate postoperative pain control, both treatments have negative side effects such as muscle weakness, delayed recovery which can delay postoperative mobilization .

The adductor canal block (ACB) is a relatively newer  analgesic block for knee arthroscopic surgery that not only blocks the femoral nerve’s largest sensory branch, but also causes a smaller decrease in quadriceps muscle strength in adult patients than the femoral nerve block (FNB)

ACB provides analgesia equivalent to FNB ,also  preserves quadriceps muscular strength better than FNB, and so allows for functional recovery within the first day after arthroscopic knee surgery according to randomized controlled trials.

The primary outcome is the assessment of duration of analgesia detected by the first analgesia rescue dose and total analgesic consumption.

Secondary outcomes includes the impact of single-shot adductor canal block using ropivacaine and butorphanol on postoperative recovery by patient  outcome assessment ,  sedation, and the side effects that could occur in the 24-hour study period in patients undertaking total knee arthroscopy.