Investigation of the Effect of Proximal and Distal Adductor Canal Block in Knee Replacement Surgery

NCT06188806 | Recruiting

• 1 other identifier: URH-AR-ZT-06
• Study Type: interventional
• Target: 78
• Locations: 1 country
• Sites: 1

Brief Summary

to investigate the effect of adductor canal block applied with two different approaches in the treatment of pain after TKA surgery on pain control and functional mobility.

Conditions

Knee Osteoarthritis

Keywords

adduktor canal block,knee artroplasti,postoperative pain

Outcome Measures

Primary Outcomes (1)

• VISUAL ANALOGUE SCALE(VAS)

  VAS pain score was evaluated as "no pain" (score=0) and "worst pain" (score=10) and was divided into 3 groups according to the World Health Organization's pain intensity scale: score \<3 mild pain, 3-6 mild-moderate. degree pain and \>6 moderate-severe pain.

  POSTOPERATIVE 6, 12 AND 24 HOURS

Secondary Outcomes (3)

• first mobilization time

  within postoperative 24 hours

• length of hospital stay

  ONE WEEK

• opioid use

  within postoperative 24 hours

Study Arms (3)

PROXİMAL ADDUKTOR CANAL BLOCK GROUP

ACTIVE COMPARATOR

Patients are placed in the supine position and a high-frequency linear probe is inserted for a cross-sectional image of the groin and thigh. The femoral nerve is identified in the short axis near the inguinal crease and the ultrasound transducer is placed caudally beyond the femoral triangle. The location of the proximal block is determined where the superficial femoral artery passes under the medial border of the sartorius muscle (usually 8-12 cm distal to the inguinal crease). Using the in-plane technique, a 100 mm peripheral nerve block needle is advanced until the tip of the needle passes the sartorius muscle and enters the adductor canal from the lateral side of the superficial femoral artery, and 20 mL 0.375% Bupivacaine is administered. To verify block success, sensory function is assessed by pinprick testing along the saphenous nerve distribution by comparing the pinprick sensation to the unaffected limb.

Other: ADDUKTOR CANAL BLOCK

DİSTAL ADDUKTOR CANAL BLOCK GROUP

ACTIVE COMPARATOR

Patients are placed in the supine position, the mid-thigh point is determined as half the distance between the groin crease and the top of the patella. After the mid-thigh mark is marked with a sterile marking pen, the ultrasound transducer is positioned for a transverse view of the adductor canal into the mid-thigh. Under USG imaging, the femoral artery and saphenous nerve are identified. The distal position is determined where the USG probe moves away from the sartorius muscle of the femoral artery and proceeds deep into the adductor hiatus, and a 100 mm block needle passes the sartorius muscle with an in plane technique and 20 mL 0.375% Bupivacaine is administered to the lateral side of the femoral artery and saphenous nerve.

Other: ADDUKTOR CANAL BLOCK

CONTROL GROUP

SHAM COMPARATOR

No nerve block procedure is applied to patients.

Other: CONTROL GROUP

Interventions

ADDUKTOR CANAL BLOCK OTHER

All patients who will undergo adductor canal block are sedated with midazolam 0.03 mg/kg in the preoperative preparation room, after standard monitoring. After 2-3 ml skin infiltration with 2% lidocaine under sterile conditions, a block is applied under USG guidance.To verify block success, sensory function is assessed by pinprick testing along the saphenous nerve distribution by comparing the pinprick sensation to the unaffected limb.All patients are monitored in the operating room and in a sitting position, 10-20 mg (2-4 ml) of heavy marcaine (0.5% bupivacaine hydrochloride and dextrose monohydrate) is applied to the subarachnoid space by entering the L3-4 or L4-5 space with a 25-gauge Whitrace needle.For postoperative multimodal analgesia, which is routinely applied to all patients, intravenous PCA (patient controlled analgesia )tramadol and paracetamol 10 mg / kg iv (8 hours apart) will be given.

DİSTAL ADDUKTOR CANAL BLOCK GROUP; PROXİMAL ADDUKTOR CANAL BLOCK GROUP

CONTROL GROUP OTHER

No nerve block procedure is applied to patients.All patients are monitored in the operating room and in a sitting position, 10-20 mg (2-4 ml) of heavy marcaine (0.5% bupivacaine hydrochloride and dextrose monohydrate) is applied to the subarachnoid space by entering the L3-4 or L4-5 space with a 25-gauge Whitrace needle.For postoperative multimodal analgesia, which is routinely applied to all patients, intravenous PCA (patient controlled analgesia) tramadol 50 mg at 10 mg / hour basal rate after loading (20 mg bolus dose + 30 minutes lock time) and paracetamol 10 mg / kg iv (8 hours apart) will be given.

CONTROL GROUP

Eligibility Criteria

• Age: 18 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Medications for unilateral TKA surgery
• Patients aged 18-85
• ASA 1-3

You may not qualify if:

• Patients under 18 years of age and over 85 years of age
• Patients with ASA 4 and above
• Patients with cognitive impairment
• Patients with application site infection
• Patients allergic to local anesthesia
• Patients receiving anticoagulant therapy
• Patients with bleeding diathesis
• Patients with chronic opioid or substance use
• Patients with insulin-dependent diabetes mellitus
• patients with neuropathy
• patients with hepatic or renal failure
• Patients who do not accept the procedure to be applied

Sponsors & Collaborators

• Umraniye Education and Research Hospital: lead

Study Sites (1)

Umraniye Education and Research Hospital

Istanbul, Umraniye, 34734, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Osteoarthritis, Knee; Pain, Postoperative

Interventions

Control Groups

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Central Study Contacts

Zeliha TUNCEL

CONTACT

+90 505 357 74 83; zelihalara@yahoo.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: head of Anesthesia and reanimation

Model Details: three groups Group 1: proximal ACB (n:26) Group 2: distal ACB(n:26) Group 3: Control group (n:26)

Study Record Dates

• First Submitted: December 18, 2023
• First Posted: January 3, 2024
• Study Start: November 10, 2023
• Primary Completion: February 27, 2026
• Study Completion: March 30, 2026
• Last Updated: November 19, 2025

Record last verified: 2025-11

Locations

TU (1)