Single-shot Adductor Canal Block With Levobupivacaine and Dexmedetomidine in Total Knee Arthroplasty
Study Details
Study Description
Brief Summary
Total knee arthroplasty surgery is associated with severe postoperative pain and adequate pain management is necessary for early postoperative mobilization and rehabilitation. Although good postoperative pain control may be achieved by continuous epidural anesthesia or femoral nerve block, both methods have adverse effects such as muscle weakness, which may delay postoperative mobilization.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2/Phase 3 |
Detailed Description
The adductor canal block (ACB) is a relatively new block providing analgesia for knee surgery, which not only blocks the largest sensory branch of the femoral nerve but also results in less reduction of quadriceps muscle strength, compared with the femoral nerve block (FNB) in adult patients.
Randomized controlled trials have revealed that ACB provides at least equal analgesia as FNB, preserves quadriceps muscle strength better than FNB, and thus allowing for functional recovery within the first 24-hour post-TKA. However, one important limitation of single-shot peripheral nerve block is the short duration of analgesia. Because the average duration of severe pain after TKA takes 2-3 days, a continuous ACB via catheter would seem to be a good choice. Unfortunately, perineural catheters may be technically difficult to insert, are prone to premature dislodgement, and may increase infection risk. There also were some case reports of local anesthetic-induced myotoxicity after continuous ACB.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: L group 20 mL of 0.25% levobupivacaine plus 1 mL normal saline |
Drug: Levobupivacaine
20 mL of 0.25% levobupivacaine plus 1 mL normal saline
|
| Experimental: LD group 20 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine |
Drug: Dexmedetomidine Hydrochloride
20 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine
|
Outcome Measures
Primary Outcome Measures
- the first analgesia rescue call. [24 hours postoperative]
time to the first analgesic request.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
ASA physical status I or II
-
undergoing elective primary total knee arthroplasty surgery under spinal anesthesia.
Exclusion Criteria:
-
Patients with a known history of significant hepatic,
-
renal, heart disease, autoimmune disease,
-
any known convulsive disorder, any psychiatric disorders, chronic pain,
-
pregnant females, regular use analgesics, anti-depressants, or opioids in the previous 2 months, revision surgery, morbid obesity, allergy to local anesthetics or morphine
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Assiut governorate | Assiut | Egypt |
Sponsors and Collaborators
- Assiut University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Bauer MC, Pogatzki-Zahn EM, Zahn PK. Regional analgesia techniques for total knee replacement. Curr Opin Anaesthesiol. 2014 Oct;27(5):501-6. doi: 10.1097/ACO.0000000000000115. Review.
- Jæger P, Koscielniak-Nielsen ZJ, Schrøder HM, Mathiesen O, Henningsen MH, Lund J, Jenstrup MT, Dahl JB. Adductor canal block for postoperative pain treatment after revision knee arthroplasty: a blinded, randomized, placebo-controlled study. PLoS One. 2014 Nov 11;9(11):e111951. doi: 10.1371/journal.pone.0111951. eCollection 2014.
- Jiang X, Wang QQ, Wu CA, Tian W. Analgesic Efficacy of Adductor Canal Block in Total Knee Arthroplasty: A Meta-analysis and Systematic Review. Orthop Surg. 2016 Aug;8(3):294-300. doi: 10.1111/os.12268. Review.
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