Using the Adductor Magnus Plain Block As an Innovative Approach for Sciatic Nerve Block for Lower Limb Surgeries.

NCT06852118 | Active Not Recruiting

• 1 other identifier: Anesth-.0435/2024 Med Research
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

the goal of this clinical trial is to compare the efficacy of adductor magnus muscle plane injection as an approach for sciatic nerve block to sub-gluteal approach in combination with femoral nerve blocks as perioperative analgesia in knee surgeries.

Conditions

Adductor Magnus Plain Injection for Sciatic Nerve Block

Keywords

sciatic nerve block; Femoral nerve; Adductor magnus muscle; knee surgeries

Outcome Measures

Primary Outcomes (2)

• Assessment of sciatic sensory block

  It will be assessed by evaluating the sharp sensation with pinprick testing, and the presence or loss of cold-warm feeling as (2 for normal sensory perception, 1 for loss of cold-warm feeling, and 0 for loss of pinprick sensation) for ciatic in the sole of foot.

  At 30 minutes after the block

• Assessment of sciatic motor block

  Sciatic block will be evaluated by the motion of the foot and ankle joint (3 for normal movement, 2 for unable to push or flex the foot against external resistance, 1 for unable to push or flex the foot against gravity and 0 for no motion

  At 30 minutes after the block

Secondary Outcomes (7)

• Postoperative pain scores

  At 1, 6, 12, and 24 hours post-operative

• The onset of sciatic sensory blockades

  Every 3 minutes with maximum time 30 minutes (if no changes within 30 min the patient will be excluded from the study)

• The duration of the sciatic nerve block procedure

  during sciatic nerve block conduction

• Visibility scores for the sciatic nerve

  during sciatic nerve block using sub gluteal approach conduction

• Visibility scores for Adductor magnus muscle (AMM)

  during sciatic nerve block using adductor magnus muscle plain block conduction

Study Arms (2)

AMM Group: Adductor Magnus Muscle Plane approach + Femoral Nerve Blocks

EXPERIMENTAL

Conduct the sciatic nerve block via adductor magnus plain injection. the femoral nerve block will be conducted as well

Procedure: AMM Group: Adductor Magnus Muscle Plane approach + Femoral Nerve Blocks

SG Group: Sciatic nerve block by sub-gluteal approach + Femoral nerve blocks

ACTIVE COMPARATOR

Conduct the sciatic nerve block via sub-gluteal approach. the femoral nerve block will be conducted as well

Procedure: SG Group: Sciatic nerve block by sub-gluteal approach + Femoral nerve blocks

Interventions

AMM Group: Adductor Magnus Muscle Plane approach + Femoral Nerve Blocks PROCEDURE

In the supine position, the femoral nerve block will be conducted using a high-frequency ultrasound probe to identify the femoral nerve just below the fascia iliaca. After proper sterilization, the needle will be advanced in-plane to inject 15 ml bupivacaine 0.5% around the nerve. After performing the femoral nerve block, the adductor magnus muscle plane block will be performed using a low-frequency ultrasound probe positioned 6 cm distal to the inguinal crease to identify the sartorius muscle, femoral artery, femoral vein, and femoral nerve on the deep side of the sartorius muscle, the probe will be slide by about 2-2.5 cm distally, where we could identify the plane between the adductor magnus and the semimembranosus muscles, and after proper sterilization, the needle will be slowly advanced until the needle tip is close to the posterior surface of the AMM, 20 mL of bupivacaine 0.5% will be injected while observing fluid distribution under the posterior surface of the AMM, Then GA.

AMM Group: Adductor Magnus Muscle Plane approach + Femoral Nerve Blocks

SG Group: Sciatic nerve block by sub-gluteal approach + Femoral nerve blocks PROCEDURE

While the patient is in the supine position, the femoral nerve block will be conducted using a high-frequency ultrasound probe to identify a cross-sectional view of the femoral nerve just below the fascia iliaca. After proper sterilization, the needle will be advanced in-plane to inject 15 ml bupivacaine 0.5% around the nerve. the patient will be turned on their sides with the operative side uppermost and flexed, the sub-gluteal sciatic nerve will be identified using a low-frequency probe, and then the same needle will be advanced the in-plane to inject 20 ml bupivacaine 0.5% around the nerve., then GA will be conducted as the other group

SG Group: Sciatic nerve block by sub-gluteal approach + Femoral nerve blocks

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• ASA (American Society of Anaesthesiologists) Physical Status I-III.
• Patients who consent to receive regional anesthesia.

You may not qualify if:

• Patients with a history of allergy to local anesthetics.
• Pre-existing neurological deficits in the lower extremities.
• Coagulopathy or anticoagulation therapy that cannot be safely discontinued.
• Infection at the site of block injection.
• Severe obesity (BMI \> 40).
• Patients with contraindications to regional anesthesia.
• peripheral neuropathy.
• Psychiatric disorders and communication difficulties.

Sponsors & Collaborators

• Mohammed Gaber Saad: lead

Study Sites (1)

Faculity of medicine - Al-Azhar University hospitals

Cairo, Cairo Governorate, 11884, Egypt

Location

Related Publications (3)

• Ben-David B, Schmalenberger K, Chelly JE. Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg. 2004 Mar;98(3):747-9, table of contents. doi: 10.1213/01.ane.0000096186.89230.56.

  PMID: 14980931 BACKGROUND

• Shanthanna H, Singh B, Guyatt G. A systematic review and meta-analysis of caudal block as compared to noncaudal regional techniques for inguinal surgeries in children. Biomed Res Int. 2014;2014:890626. doi: 10.1155/2014/890626. Epub 2014 Aug 5.

  PMID: 25162033 BACKGROUND

• Wang L, Qu Y, Deng Y, Li J, Liu Y, Wu C. Evaluation of a New Method of Sciatic Nerve Block: A Prospective Pilot Study. J Pain Res. 2023 Jun 16;16:2091-2099. doi: 10.2147/JPR.S404489. eCollection 2023.

  PMID: 37346396 BACKGROUND

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Lecturer of anesthesia, intensive care and pain medicine

Study Record Dates

• First Submitted: February 22, 2025
• First Posted: February 28, 2025
• Study Start: October 1, 2024
• Primary Completion: June 30, 2025
• Study Completion: June 30, 2025
• Last Updated: February 28, 2025

Record last verified: 2025-02

Locations

EG (1)