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| Name | Class |
|---|---|
| Ulusoy, Emre, M.D. | INDIV |
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Total knee arthroplasty (TKA) is a surgical procedure frequently associated with moderate-to-severe postoperative pain. While Adductor Canal Block (ACB) has demonstrated analgesic efficacy in TKA, the Erector Spinae Plane Block (ESPB) is also being utilized as part of multimodal analgesia for postoperative pain management in lower extremity surgeries. Currently, there is a gap in the literature as no studies have directly compared the efficacy of ACB and ESPB for pain management following TKA. The primary objective of this study is to compare the efficacy of these two analgesic methods in the context of postoperative analgesia management after total knee arthroplasty.
In our clinic, various regional blocks are applied for analgesia or anesthesia purposes in many surgeries, including knee surgery. For knee surgery, adductor canal block, lumbar epidural analgesia, genicular block, erector spinae plane block, and iPACK block can be used. In our clinic, erector spinae plane block and adductor canal block are routinely applied to knee surgery patients. In our study, we aimed to contribute to the literature by comparing patient satisfaction surveys and pain follow-up in patients undergoing knee arthroplasty who received adductor canal block versus lumbosacral erector spinae plane block, both applied with PROSPECT protocols for postoperative analgesia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adductor canal block | Active Comparator | Patients will receive an adductor canal block preoperatively. |
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| Erector spinae plane block | Active Comparator | Patients will receive a lumbosacral erector spinae plane block in the preoperative period. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Postoperative analgesia management | Other | After determining the L5-S1 level with ultrasound guidance, an 80 mm block needle (Stimuplex Ultra®, Braun, Melsungen, Germany) will be advanced in a cranio-caudal direction. Following hydrodissection, 30 ml of 0.25% bupivacaine local anesthetic solution containing 7.5 mcg of epinephrine (1:200,000) will be administered. |
| Measure | Description | Time Frame |
|---|---|---|
| opioid consumption | Tramadol will be prepared as 5mg/ml and patient-controlled analgesia will be administered without basal infusion, with a locking time of 20 minutes and a bolus dose of 10mg. | 0-48 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain scores (Numerical rating scale) (0-meaning "no pain" to 10-meaning "worst pain imaginable") | Postoperative 48 hours period. Patients' pain scores will be questioned at 0, 2, 4, 8, 16, 24 and 48 hours. | The NRS scores of the patients will be evaluated at the postoperative 0, 2, 4, 8, 16, 24 and 48 hours. |
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Inclusion Criteria Patients aged 18-65 years Patients scheduled for elective total knee arthroplasty under spinal anesthesia ASA physical status I-II Written informed consent Exclusion Criteria Refusal to participate Coagulopathy or inability to discontinue anticoagulant therapy appropriately Allergy or toxicity history to local anesthetics or opioids Infection at the injection site Severe cardiac, hepatic, or renal failure Diabetes mellitus-related neuropathy Peripheral neuropathy or motor-sensory deficit in the relevant extremity Psychiatric disease, cognitive impairment, or inability to cooperate Substance or alcohol abuse Pregnancy, suspected pregnancy, or breastfeeding Body mass index >40 kg/m² Failed spinal anesthesia or need for additional intraoperative anesthesia/analgesia
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bursa City Hospital | Bursa | Nilüfer | 16110 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31879373 | Background | Tran J, Chan VWS, Peng PWH, Agur AMR. Evaluation of the proximal adductor canal block injectate spread: a cadaveric study. Reg Anesth Pain Med. 2019 Dec 25:rapm-2019-101091. doi: 10.1136/rapm-2019-101091. Online ahead of print. | |
| 30124351 | Background | Tao Y, Zheng SQ, Xu T, Wang G, Wang Y, Wu AS, Yue Y. Median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block. J Int Med Res. 2018 Oct;46(10):4207-4213. doi: 10.1177/0300060518791685. Epub 2018 Aug 20. |
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Individual participant data (IPD) will not be shared
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he patient and the outcomes assessor who performs postoperative pain evaluation will not know the group
|
| Postoperative analgesia management | Other | After identifying the adductor canal with a high-frequency linear US probe (GE ML6-15-D Matrix Linear), 30 ml of 0.25% bupivacaine local anesthetic solution containing 7.5 mcg of epinephrine (1:200,000) will be administered into the adductor canal using an 80 mm block needle (Stimuplex Ultra®, Braun, Melsungen, Germany). |
|
| Global recovery scoring system (patient satisfaction scale) |
Researchers will use the Turkish version of the Quality Improvement Survey/QoR-15. PART A: Participants will be asked by researchers how they felt in the last 24 hours.(0 to 10, where: 0 = none of the time [poor] and 10 = all of the time [excellent]) 1. Able to breathe easily 2. Been able to enjoy food 3. Feeling rested 4. Have had a good sleep 5. Able to look after personal toilet and hygiene unaided 6. Able to communicate with 7. Getting support from hospital doctors and nurses 8. Able to return to work or usual home activities 9. Feeling comfortable and in control 10. Having a feeling of general well-being PART B Participants will be asked by the researchers whether they have experienced any of the following in the last 24 hours. (10 to 0, where: 10 = none of the time [excellent] and 0 = all of the time [poor]) 11. Moderate pain 12. Severe pain 13. Nausea or vomiting 14. Feeling worried or anxious 15. Feeling sad or depressed |
| The quality of recovery will be evaluated out of a total of 150 points according to the QoR-15 test to be applied at the portoperative 48th hour. |
| Determine the time to first postoperative mobilization (The Timed Up and Go - TUG test): | Place a chair in a location where walking can be observed. The area should be free of obstacles and interruptions. Measure a distance of 3 meters and draw a line on the floor at this distance. Use colored tape if available (to be clearly visible from the floor). Seat the patient in a chair, with access to their usual walking aid if applicable. Ask the patient to "start" and begin the timer. The patient stands up, walks past the 3-meter mark, turns, then walks back to the chair and sits down again. Record the time taken to complete the entire maneuver. | The Timed Up and Go (TUG) test will be performed at the 20th minute after the preoperative block. |
| 36530341 | Background | Gupta A, Kaur J, Kumar R. Unilateral sacral erector spinae plane block for lower limb surgery in children. Anaesth Rep. 2022 Dec 14;10(2):e12199. doi: 10.1002/anr3.12199. eCollection 2022 Jul-Dec. |
| 30636313 | Background | Browne W, Nair BKR. The Timed Up and Go test. Med J Aust. 2019 Jan;210(1):13-14.e1. doi: 10.5694/mja2.12045. Epub 2018 Dec 28. No abstract available. |
| 34188648 | Background | Diwan S, Nair A. Lumbar erector spinae plane block obtunding knee and ankle reflexes. Saudi J Anaesth. 2021 Apr-Jun;15(2):222-224. doi: 10.4103/sja.SJA_79_20. Epub 2021 Apr 1. |
| 33585088 | Background | Kaya C, Dost B, Tulgar S. Sacral Erector Spinae Plane Block Provides Surgical Anesthesia in Ambulatory Anorectal Surgery: Two Case Reports. Cureus. 2021 Jan 9;13(1):e12598. doi: 10.7759/cureus.12598. |
| 36511494 | Background | Selvi O, Azizoglu M, Temel G, Tulgar S, Chitneni A, Cinar EN, Ozer Z, Gurkan Y. Translation and Validation of the Turkish Version of the Quality of Postoperative Recovery Score QoR-15: A Multi-Centred Cohort Study. Turk J Anaesthesiol Reanim. 2022 Dec;50(6):443-448. doi: 10.5152/TJAR.2022.21417. |