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Aim of this study is to evaluate the effects of the adductor canal block on the early and medium term ( 1 month) rehabilitation compared to the continuous femoral block commonly used in the knee prosthesis.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adductor canal | Experimental | All patients in the arm will receive continuous adductor canal block under ultrasound guidance. 10ml of Ropivacaine 0,75%, BBraun, Germany, will be injected to dilate adductor canal. After catheter insertion 10ml of Ropivacaine 0,75% will be injected. |
|
| Femoral | Active Comparator | All patients in the arm will receive continuous femoral nerve block under ultrasound guidance. Correct position of catheter will be check with injection of 20ml Ropivacaine 0,75% BBraun, Germany medial to femoral nerve. |
|
| Controls | Placebo Comparator | No patients of this arm receive continuous nerve block. Intravenous opioids analgesia will be administered. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Adductor canal | Procedure | Perinervous catheter (stimulong sono- Pajunk, Germany) will be insert in adductor canal through tuohy needle (18G, 100mm length) under ultrasound guidance. |
| Measure | Description | Time Frame |
|---|---|---|
| Up and Go test | Knee functional evaluation at 5th postoperative day. "up and go" test: time need to get up from a chair, walk for 3 meters, and come back to seat down on the chair | 5th postoperative day |
| Measure | Description | Time Frame |
|---|---|---|
| VAS score | Evaluation of VAS static and VAS dynamic during hospital stay | up to POD5 |
| Morphine request | Opioids consumption will be recorded throughout postoperative period |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gianluca Cappelleri, M.D. | ASST Gaetano Pini-CTO | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istituto ortopedico Gaetano Pini | Milan | Italy |
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| Femoral | Procedure | Perinervous catheter (stimulong sono- Pajunk, Germany) will be insert between femoral nerve and femoral artery through tuohy needle (18G, 100mm length) under ultrasound guidance. |
|
| Spinal Anesthesia | Procedure | Spinal anesthesia will be perform at L3-L4 or L4-L5 level. Levobupivacaine 0,5% 12mg will be injected. |
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| Local anesthetic infusion | Procedure | Continuous infusion of levobupivacaine 0,125% at 8ml/h rate through perinervous catheter until 5th postoperative day. |
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| Intravenous analgesia | Procedure | Ketorolac 30mg 3 times/day and morphine Patients Control Analgesia (1mg/h, max 4mg/h) administered. |
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| Ropivacaine 0,75% | Drug |
|
| Levobupivacaine 0,5% | Drug |
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| Levobupivacaine 0,125% | Drug |
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| Ketorolac 30mg | Drug |
|
| Morphine | Drug |
|
| stimulong sono, Pajunk, Germany | Device |
|
| up to POD5 |
| Range of motion | Physiotherapist measures the maximum active/passive range of motion | 5th postoperative day |
| Falling risk | Evaluation of falling risk with Berg Balance Scale | 5th postoperative day |
| Quadriceps strength | evaluate muscle strength with an isometric force dynamometer to measure the force produced during a maximum voluntary isometric contraction in a lying position by the knee flex to 90°. | 5th postoperative day |
| ID | Term |
|---|---|
| D000775 | Anesthesia, Spinal |
| D020910 | Ketorolac |
| D009020 | Morphine |
| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D007213 | Indomethacin |
| D007211 | Indoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
| D000470 | Alkaloids |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |
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