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Anterior cruciate ligament (ACL) reconstruction is frequently associated with moderate to severe postoperative pain, which can delay mobilization and rehabilitation. The adductor canal block (ACB) is widely used for postoperative pain management because it provides effective analgesia while preserving quadriceps muscle strength. However, pain originating from the medial aspect of the knee may not be adequately controlled with ACB alone because the nerve to the vastus medialis may not be consistently anesthetized.
This prospective randomized controlled trial evaluates whether adding a vastus medialis nerve block (VMNB) to a standard adductor canal block improves postoperative pain control in patients undergoing elective arthroscopic ACL reconstruction. Participants are randomly assigned to receive either ACB alone or ACB combined with VMNB before surgery, while all patients receive the same standardized general anesthesia, surgical technique, and postoperative analgesic regimen.
The primary outcome is postoperative pain intensity measured using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours after surgery. Secondary outcomes include postoperative opioid consumption, time to first mobilization, length of hospital stay, and block-related complications. The results of this study may help determine whether the addition of a vastus medialis nerve block provides clinically meaningful benefits and may contribute to improving postoperative pain management following ACL reconstruction.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adductor Canal Block | Active Comparator | Participants received an ultrasound-guided adductor canal block before elective arthroscopic anterior cruciate ligament reconstruction. All participants received standardized general anesthesia and postoperative analgesic management. |
|
| Adductor Canal Block Plus Vastus Medialis Nerve Block | Active Comparator | Participants received an ultrasound-guided adductor canal block combined with an ultrasound-guided vastus medialis nerve block before elective arthroscopic anterior cruciate ligament reconstruction. All participants received standardized general anesthesia and postoperative analgesic management. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Adductor Canal Block (ACB) Only | Procedure | An ultrasound-guided adductor canal block was performed before induction of general anesthesia using 15-20 mL of 0.25% bupivacaine as part of the multimodal analgesia protocol for anterior cruciate ligament reconstruction. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Pain Intensity | Postoperative pain intensity will be assessed using the 10-cm Visual Analog Scale (VAS) at rest at 1, 6, 12, and 24 hours after surgery. VAS scores range from 0 (no pain) to 10 (worst imaginable pain). | 24 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Opioid Consumption | Total opioid consumption during the first 24 postoperative hours will be calculated as intravenous morphine equivalent dose (mg). | 24 hours after surgery |
| Time to First Mobilization |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| SBU Bagcilar Education and Training Hospital | Istanbul | ABD Dışında | 34400 | Turkey (Türkiye) |
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Participants were randomly assigned in a 1:1 ratio to receive either an adductor canal block alone or an adductor canal block combined with a vastus medialis nerve block before elective arthroscopic anterior cruciate ligament reconstruction. Both groups received standardized general anesthesia, perioperative care, and postoperative analgesic management.
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| Vastus Medialis Nerve Block | Procedure | An ultrasound-guided vastus medialis nerve block was performed before induction of general anesthesia using 5-10 mL of 0.25% bupivacaine in addition to the adductor canal block. |
|
Time from completion of surgery to the patient's first successful ambulation, recorded in hours.
| 24 hours after surgery |
| Length of Hospital Stay | Length of postoperative hospital stay measured in hours from the end of surgery until hospital discharge. | 24 hours after surgery |
| ID | Term |
|---|---|
| D000070598 | Anterior Cruciate Ligament Injuries |
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D012847 | Single Person |
| ID | Term |
|---|---|
| D017533 | Marital Status |
| D005191 | Family Characteristics |
| D003710 | Demography |
| D011154 | Population Characteristics |
| D012959 | Socioeconomic Factors |
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