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The purpose of this study is to compare the analgesic outcomes (time to first analgesic request, total amount of analgesic consumption, and pain scores) following total knee arthroplasty by either combined biceps femoris short head block and adductor canal block or genicular nerve block in elderly patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group (C) | Active Comparator | The patient will receive combined biceps femoris short head block and adductor canal block |
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| Group(G) | Active Comparator | The patient will receive genicular nerve block |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Combined biceps femoris short head block and adductor canal block | Other | Adductor Canal Block high-frequency probe will be placed transversely on the anterior thigh midpoint between inguinal crease and medial condyle (depth 3-5 cm). The needle will be advanced in-plane from lateral to medial through sartorius or vastus medialis muscle toward the femoral artery. Then (10 ml of 0.25% bupivacaine and 2 mg dexamethasone) will be injected after negative aspiration, with confirming spread around the artery without vascular puncture. Biceps femoris short head block The probe will be placed on the distal posterior thigh to visualize biceps femoris muscle near the lateral supracondylar line of the femur. The needle will be inserted to the interface between biceps femoris and femur cortex. Then (25 ml of 0.25% bupivacaine and 2 mg dexamethasone), with observing muscle lift and circumferential spread along the bone surface . |
| Measure | Description | Time Frame |
|---|---|---|
| Time of first rescue analgesia (naluphine) | to the duration from the block to the moment when the patient first requires or requests supplemental nalbuphine due to breakthrough pain | 24 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| block performance time | time refers to the duration required to prepare, image (e.g., via ultrasound), insert the needle, and inject local anesthetic to complete a regional nerve block procedure. | time of performance of the block |
| Pain intensity |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Marwa M Medhat, M.D | Contact | 01002828937 | medhatmarwa9@gmail.com | |
| Howida A Kamal, M.D | Contact | 01225096755 | K.Howida@yahoo.com |
| Name | Affiliation | Role |
|---|---|---|
| Howida A Kamal, M.D | faculty of medicine,zagazig university Egypt | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Medicine,Zagazig University | Zagazig | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34193634 | Background | You D, Qin L, Li K, Li D, Zhao G, Li L. A meta-analysis on advantages of peripheral nerve block post-total knee arthroplasty. Korean J Pain. 2021 Jul 1;34(3):271-287. doi: 10.3344/kjp.2021.34.3.271. |
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| Genicular nerve block | Other | Position the patient will be placed in supine position with the knee slightly flexed via a pillow in the popliteal fossa. Use a high-frequency linear ultrasound transducer. Superolateral genicular nerve (SLGN): the transducer will be placed coronally over lateral femoral epicondyle, with sliding proximally to femur metaphysis; identifying artery between vastus lateralis fascia and bone. Superomedial genicular nerve (SMGN): the transducer will be placed coronally over medial femoral epicondyle, proximal to adductor tubercle at femur metaphysis; artery between vastus medialis fascia and bone. Inferomedial genicular nerve (IMGN): the transducer will be placed coronally over medial tibial condyle, distal to metaphysis; artery beneath medial collateral ligament. • Inferolateral genicular nerve (ILGN, optional): the transducer will be placed coronally over lateral tibial epicondyle to fibula head; artery between collateral ligament and tibia |
|
10-point NRS [(0 = no pain, 10 = worst imaginable pain), 1-3: Mild pain (nagging, annoying, slightly interfering with activities of daily living (ADLs), 4 - 6: Moderate pain (significantly interfering with ADLs, 7 - 10: Severe pain (disabling, unable to perform ADLs)](streamdown:incomplete-link)
| 30 minutesn2, 4, 8, 12, 18 , and 24 hours postoperative |
| Total amount of rescue analgesia (nalbuphine) | the cumulative dose of nalbuphine administered as supplemental pain relief during a defined postoperative observation period, typically when pain scores exceed a predefined threshold like NRS ≥4 | first 24 hours postoperative |
| assess functional recovery | (knee range of motion active flexion /extension, | at 12 hours and 24 hours postoperative |
| patient's satisfaction | The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia) | 24 hours postoperative |
| Block related complications | (motor weakness, hematoma, local anesthetic toxicity,..) | 24 hours postoperative |