Single-injection Modified 4 in 1 Block as Postoperative Analgesia in Total Knee Arthroplasty
- Conditions
- Total Knee Arthroplasty
- Interventions
- Procedure: Ultrasound guided single injection modified 4 in 1 block techniqueProcedure: Ultrasound guided adductor canal block technique
- Registration Number
- NCT05447871
- Lead Sponsor
- Mansoura University
- Brief Summary
Patients suffer from moderate to severe pain after TKA. Patients are asked to begin functional exercise as early as possible after surgery, and that requires adequate control of postoperative pain. Regional anesthesia divides into non-motor sparing peripheral nerve blocks as femoral n. block and sciatic n. block and motor sparing peripheral nerve block as adductor canal block and IPACK but these blocks have many drawbacks.
So new studies found that a modified 4 in-1 block blocks all these nerves and produces adequate analgesia without sparing areas.
- Detailed Description
Total knee arthroplasty (TKA) is regarded as the most effective method to reduce knee pain and improve knee function in patients with advanced knee osteoarthritis. Postoperative pain is an unpleasant experience for TKA and this pain might greatly influence patients' early rehabilitation.
Almost 60% of patients suffer moderate to severe pain after TKA and 25% of them could even develop related complications, such as longer hospitalization stays, unanticipated hospital admissions, readmissions, etc.
With the development of enhanced recovery after surgery, patients are asked to begin exercise as early as possible after surgery, and that requires adequate control of postoperative pain.
Multimodal systemic analgesia plays an essential role in controlling postoperative pain after TKA by controlling the inflammatory process, dealing with the neuropathic component of pain, and thus reducing the severity of pain.
Multimodal analgesia includes more than one pain-control modality (systemic analgesia and regional anaesthesia). Systemic analgesia includes acetaminophen, nonsteroidal anti-inflammatory drugs, steroids and opioids. Regional anaesthesia includes epidural analgesia, femoral n. block, adductor canal block, sciatic n. block, IPACK, etc. Regional anaesthesia divides into non-motor sparing peripheral nerve blocks as femoral n. block and sciatic n. block and motor sparing peripheral nerve block as adductor canal block and IPACK.
But these blocks have many drawbacks. Femoral n. block is associated with quadriceps muscle weakness leading to delay in patient's mobility. Sciatic n. block also causes foot drop. The Adductor canal block does not cover the skin on the back of the knee. Surgeons refuse IPACK because of diffusion of local anaesthetics disturbs the anatomy of the surgical field.
The Modified 4 in 1 block technique aims to block four nerves (saphenous nerve, obturator nerve, nerve to vastus medialis and sciatic nerve) through a single injection point by spreading up to the adductor canal in midthigh and below to the popliteal fossa. The investigator will conduct this randomized clinical trial to evaluate the quality of postoperative analgesia produced by a single injection modified 4 in 1 block and midsartorius adductor canal block with regard to total analgesic consumption in the first 24 hours postoperatively
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 90
- Body mass index (BMI) of 19-30 kg/m2
- American Society of Anesthesiologists (ASA) functional status of I-III
- Drug hypersensitivity
- coagulopathy
- infection at the site of injection
- Traumatic arthirits
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Ultrasound guided single injection modified 4 in 1 block technique Ultrasound guided single injection modified 4 in 1 block technique Patients in this group will receive ultrasound guided single injection modified 4 in 1 block with 25 ml bupivacaine 0.25% Ultrasound guided single injection modified 4 in 1 block technique Bupivacaine 0.25% Patients in this group will receive ultrasound guided single injection modified 4 in 1 block with 25 ml bupivacaine 0.25% Ultrasound guided adductor canal block technique Ultrasound guided adductor canal block technique Patients in this group will receive ultrasound guided aduuctor canal block with 20 ml bupivacaine 0.25% Ultrasound guided adductor canal block technique Bupivacaine 0.25% Patients in this group will receive ultrasound guided aduuctor canal block with 20 ml bupivacaine 0.25%
- Primary Outcome Measures
Name Time Method Total amount of postoperative analgesia in first 24 hours in first 24 hours calculate total amount of morphine hydrochloride which patient will need in first 24 hours postoperative.
- Secondary Outcome Measures
Name Time Method intraoperative non invasive blood pressure(NIBP) mmHg every 10 minutes after spinal anesthesia till the end of the surgery NIBP will be measured and recorded.
intraoperative heart rate beat per minute every 10 minutes after spinal anesthesia till the end of the surgery. heart rate will be monitored and recorded.
Duration of sensory block. 3, 6, 12, 24 hours postoperative return of pinbrick sensation on the lateral aspect of the foot (S1)
postoperative hypotension mmHg at 1, 3, 6, 12 hours postoperative blood pressure will be measured and recorded
Duration of motor block. 3, 6, 12, 24 hours postoperative motor block is tested and recoded every 30 min till Bromage score is zero
Total distance patient will be able to ambulate on first postoperative day on first postoperative day the distance that patient will be able to walk on the first postoperative day (meters)
Trial Locations
- Locations (1)
Mansoura University
🇪🇬Mansourah, DK, Egypt