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Total knee replacement (TKR) is considered the most effective and safe method of radical treatment of late stages of knee osteoarthritis. A well-known problem of TKR is a severe postoperative pain syndrome, which is observed in more than 50% of patients.
Femoral nerve block (FNB) is the "gold standard" for continuous postoperative analgesia after total knee replacement, as it is effective in reducing the frequency of use of opioid analgetics and reduce the duration of hospitalization. At the same time, the negative effect of this method is the motor blockade of the quadriceps femoris muscle which leads to functional impairment and is associated with an increased risk of falling.
Adductor canal block (ACB) provides adequate analgesia comparable to femoral nerve block. Moreover, ACB doesn't affect the motor function of the quadriceps femoris muscle.
The possibility of enhanced recovery after total knee replacement is the reason to compare single-shot adductor canal block and continuous femoral nerve block.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single-shot adductor canal block | Experimental |
| |
| Continuous femoral nerve block | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Single-shot adductor canal block | Procedure | Postoperative analgesia in this group will be carried out by a single-shot bolus of 20 ml Ropivacaine 0.5% in the region of the middle third of the adductor canal. |
| Measure | Description | Time Frame |
|---|---|---|
| Ambulation distance | Less meters means worse outcome | postoperative day 1 |
| Measure | Description | Time Frame |
|---|---|---|
| Ambulation distance | Less meters means worse outcome | postoperative day 2 |
| Timed up and go test | More seconds means worse outcome | postoperative day 1 |
| Measure | Description | Time Frame |
|---|---|---|
| intravascular local anesthetic injection | frequency of intravascular local anesthetic injection | 30 day |
| neuropathy after the procedure | frequency of neuropathy after the procedure |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Valery Likhvantsev | Contact | +79036235982 | lik0704@gmail.com | |
| Levan Berikashvili | Contact | +79263308968 | levan.berikashvili@mail.ru |
| Name | Affiliation | Role |
|---|---|---|
| Valery Likhvantsev | Negovsky Reanimatology Research Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Hospital on Yauza | Recruiting | Moscow | 111033 | Russia |
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| Continuous femoral nerve block | Procedure | Postoperative analgesia in this group will be carried out by continuous infusion of local anesthetics through a catheter installed to the femoral nerve in the area of the femoral triangle. Ropivacaine 0.2% solution will be used for postoperative analgesia. Local anesthetic infusion rate is 4 ml/h to 10 ml/h. |
|
| Timed up and go test | More seconds means worse outcome | postoperative day 2 |
| 10 meters walk test | More seconds means worse outcome | postoperative day 1 |
| 10 meters walk test | More seconds means worse outcome | postoperative day 2 |
| 30 seconds chair stand test | Less exercise done means worse outcome | postoperative day 1 |
| 30 seconds chair stand test | Less exercise done means worse outcome | postoperative day 2 |
| 5 times sit to stand test | More seconds means worse outcome | postoperative day 1 |
| 5 times sit to stand test | More seconds means worse outcome | postoperative day 2 |
| time to readiness to dicharge | time from the day of surgery to the day of readiness to discharge | 30 day |
| length of hospitalization | time from the day of surgery to the day of discharge | 30 day |
| 30 day |
| ID | Term |
|---|---|
| D020370 | Osteoarthritis, Knee |
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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