"The Effect of Adductor Canal Block Performed With Postoperative Thigh Tourniquet Application on Pain After Total Knee Arthroplasty"

NCT07539467 | Enrolling By Invitation DMC

• 1 other identifier: AEŞH-EK-2025-245
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The biggest fear for patients undergoing knee replacement surgery is that persistent pain felt at the back of the knee postoperatively. While regional anesthesia is generally successful at numbing the front of the knee, managing pain in the posterior (back) area is not always easy. In this study, we tested a new method designed to alleviate pain in the back of the knee and improve patient comfort.

Conditions

Total Knee Arthroplasty for Gonarthrosis

Keywords

adductor canal block; Opioid consumption; Postoperative analgesia; Total knee arthroplasty

Outcome Measures

Primary Outcomes (1)

• This method aims to alleviate posterior knee pain and decrease overall VAS scores

  Visual Analog Scale (VAS): A scale where patients rate their pain intensity from 0 (no pain) to 10 (unbearable pain).

  At 3, 8, 12, and 24 hours post-block

Secondary Outcomes (1)

• To decrease cumulative opioid requirements and facilitate mobilization while preserving muscle strength

  at 3,8,12,24. post-block hours

Study Arms (2)

Standard Adductor Canal Block Group (S-ACB)

ACTIVE COMPARATOR

Participants received a standard ultrasound-guided distal adductor canal block. During the procedure, 20 mL of 0.25% bupivacaine was injected. In this group, no tourniquet application or additional pressure modification was performed prior to the injection. The technique relied on the natural and passive distribution of the local anesthetic within the canal.

Procedure: Standard Adductor Canal Block (S-ACB)

Tourniquet-Assisted Adductor Canal Block Group (T-ACB)

EXPERIMENTAL

Participants received an ultrasound-guided distal adductor canal block. During the procedure, a pneumatic tourniquet placed on the proximal thigh was inflated for 3-5 minutes (at a pressure of approximately 142-202 mmHg), and 20 mL of 0.25% bupivacaine was injected. Following this, the tourniquet was deflated, and a second 20 mL dose of 0.25% bupivacaine was administered. The aim of this modification was to enhance the distribution of the local anesthetic through the adductor hiatus toward the neural networks of the posterior knee (posterior fascial planes)

Procedure: Tourniquet-Assisted Adductor Canal Block (T-ACB) grou

Interventions

Tourniquet-Assisted Adductor Canal Block (T-ACB) grou PROCEDURE

Participants received an ultrasound-guided distal adductor canal block. The procedure was performed in two stages: First, a pneumatic tourniquet placed on the proximal thigh was inflated for 3-5 minutes (at a pressure of approximately 142-202 mmHg), during which 20 mL of 0.25% bupivacaine was injected. Subsequently, the tourniquet was deflated, and an additional 20 mL of 0.25% bupivacaine was administered, reaching a total volume of 40 mL. This technique aimed to enhance the distribution of the local anesthetic through the adductor hiatus to the popliteal plexus at the posterior aspect of the knee.

Tourniquet-Assisted Adductor Canal Block Group (T-ACB)

Standard Adductor Canal Block (S-ACB) PROCEDURE

Participants received a standard ultrasound-guided distal adductor canal block. During the procedure, 20 mL of 0.25% bupivacaine was injected in a single dose without any tourniquet modification or additional pressure application. The technique relied on the natural, passive, and anatomical distribution of the local anesthetic within the adductor canal.

Standard Adductor Canal Block Group (S-ACB)

Eligibility Criteria

• Age: 40 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may not qualify if:

• To ensure methodological standardization, the following cases were excluded:
• Patients undergoing revision surgery.
• Those undergoing unicompartmental (unicondylar) knee replacement, as the severity of surgical trauma differs from total replacement.
• Bilateral cases, to prevent potential bias in assessing postoperative opioid consumption and pain scores.
• Additionally, patients were excluded if:
• The surgical duration exceeded 180 minutes.
• There was a known history of coagulopathy, peripheral neuropathy, or allergy to local anesthetics.
• The spinal anesthesia was insufficient, requiring a conversion to general anesthesia.

Sponsors & Collaborators

• Ankara Etlik City Hospital: lead

Study Sites (1)

Ankara Etlik Şehir Hastanesi

Ankara, 06690, Turkey (Türkiye)

Location

Related Publications (1)

• Sonawane K, Dixit H, Mistry T, Gurumoorthi P, Balavenkatasubramanian J. Anatomical and Technical Considerations of the Hi-PAC (Hi-Volume Proximal Adductor Canal) Block: A Novel Motor-Sparing Regional Analgesia Technique for Below-Knee Surgeries. Cureus. 2022 Feb 6;14(2):e21953. doi: 10.7759/cureus.21953. eCollection 2022 Feb.

  PMID: 35282508 RESULT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: Patients' relatives helped them describe their pain
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: consultant md

Model Details: "The control group consisted of patients who underwent the routine adductor canal block, whereas the tourniquet group included patients who received the block with the application of a tourniquet."

Study Record Dates

• First Submitted: April 10, 2026
• First Posted: April 20, 2026
• Study Start: March 1, 2026
• Primary Completion: April 15, 2026
• Study Completion: April 16, 2026
• Last Updated: April 20, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)