Adductor Canal Block Methods in Bilateral Total Knee Arthroplasty

Comparison of Surgeon-Performed Intraoperative Adductor Canal Block and Ultrasound-Guided Anesthesiologist-Performed Block in Bilateral Total Knee Arthroplasty

This study aims to compare the analgesic efficacy of surgeon-performed intraoperative adductor canal block (ACB) and ultrasound-guided anesthesiologist-performed ACB in patients undergoing bilateral total knee arthroplasty (TKA). In a prospective, randomized paired design, each patient will receive surgeon-performed ACB on one knee and anesthesiologist-performed ACB on the contralateral knee.

The primary outcome is postoperative pain measured using the Numeric Rating Scale (NRS), and the study is designed to evaluate the non-inferiority of surgeon-performed ACB. Secondary outcomes include opioid consumption, time to first ambulation, length of hospital stay, postoperative complications, and patient-reported outcome measures (PROMs).

Additionally, postoperative ultrasound evaluation will be performed to assess the distribution pattern of local anesthetic within the adductor canal, including cross-sectional area and longitudinal spread. This study is expected to provide evidence regarding the clinical effectiveness and technical accuracy of surgeon-performed ACB in comparison with the conventional ultrasound-guided technique.

Inclusion Criteria:

• Adult patients aged 19 years or older
• Patients scheduled for bilateral total knee arthroplasty
• Patients who provide written informed consent

Exclusion Criteria:

• Refusal to participate or inability to provide informed consent
• Neurological or psychiatric conditions affecting cooperation (e.g., dementia, delirium)
• Pre-existing neurological or anatomical abnormalities of the lower extremities
• Chronic opioid use or opioid dependence
• Coagulation disorders or contraindications to nerve block
• Pregnancy
• Cases in which ultrasound evaluation is technically not feasible