Concentration Effect of Local Anesthetics on Femoral Nerve Block Efficiency
Study Details
Study Description
Brief Summary
US-guided femoral nerve block is used effectively in post-operative pain management in the surgical treatment of the lower extremity. However, the volume and concentration of the local anesthetic drug to be administered remains controversial. In this prospective, randomized, double-blinded study, patients who underwent unilateral primary total knee arthroplasty and successfully performed spinal anesthesia with standard method and dosage, will be selected for US-guided femoral nerve block after the operation. Patients will be divided into three groups with simple randomization. The First group will be determined as the control group (GCont) and only dressing will be applied to the patients. For second group(G125), 0,125% 20 ml local anesthetic and for the third group (G25), 0,25% 10 ml local anesthetic will be administered to the femoral nerve without changing the drug dose (25 mg bupivacaine). Whether there is a difference between post-op analgesia durations, motor block formation, mobilization time and 90° flexion time between the groups will be investigated.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 4 |
Detailed Description
All patients scheduled for total knee arthroplasty will be evaluated before the operation. Eligible patients will be informed about the study and "Numeric Rating Scale" for pain evaluation. Then, patients will be asked for informed consent. After approval from the local research ethics committee, first patient will be recruited for study and patient's group will be determined by dice roll(1,4: GCont - 2,5: G125 - 3,6: G25). Patients who are scheduled for primary total knee arthroplasty under spinal anesthesia with a planned sensory block level between T4 and T7 dermatomes, will be recruited and assigned to a group. After successfully completed surgery, patients will be administered femoral nerve block or only dressing according to the relevant group. Before femoral nerve block is performed, patients will be re-informed about Numeric Rating Scale(NRS) and will be asked to rate their pain at the moment.
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Control Group(GCont) patients will only be applied sterile dressing for the purpose of blinding the patient and the follow-up physician.
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0.125% Bupivacaine Group(G125) patients will be administered femoral block with 20 ml 0.125% Bupivacaine by an experienced anesthesiologist.
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0.25% Bupivacaine Group(G25) patients 10ml will be administered femoral block with 0.25% Bupivacaine by an experienced anesthesiologist.
The procedures will be performed in the operating room under both US and nerve stimulator guidance. Patients will be followed-up in post-anesthesia care unit and in the ward for 48 hours. Scheduled and on-demand(Tramadol) medication for analgesia will be ordered and nurses will be informed about the study. Patients' pain scores and ambulation times will be followed-up by another anesthesiologist and on-demand medication will be recorded and monitored from hospital's computer based hospital management program online. Patients will be followed-up for six months after the surgery in order to explore potential long term benefits and complications.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Sham Comparator: GCont Only dressing will be applied to patients without actually nerve block performed |
Other: Dressing
Only dressing will be applied to related area to protect blindness between groups
|
| Active Comparator: G125 Block Ultrasound Guided Femoral Nerve Block: 20ml Bupivacaine 0.125% Injectable Solution will be administered for femoral nerve block. 5ml %0,5 Bupivacaine will be diluted with 15ml Saline solution. |
Procedure: Ultrasound Guided Femoral Nerve Block
Femoral nerve block will be applied post-operatively with guidance of USG and nerve stimulator
Other Names:
Drug: Bupivacaine 0.125% Injectable Solution
Perineural Injection
Other Names:
|
| Active Comparator: G25 Block Ultrasound Guided Femoral Nerve Block: 10ml Bupivacaine 0.25% Injectable Solution will be administered for femoral nerve block. 5ml %0,5 Bupivacaine will be diluted with 5ml Saline solution. |
Procedure: Ultrasound Guided Femoral Nerve Block
Femoral nerve block will be applied post-operatively with guidance of USG and nerve stimulator
Other Names:
Drug: Bupivacaine 0.25% Injectable Solution
Perineural Injection
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Post-operative pain assessed by Numeric Rating Scale (NRS) [30th minute postoperatively]
Pain scores will be recorded as reported by the patient according to NRS
- Post-operative pain assessed by Numeric Rating Scale (NRS) [1st hour postoperatively]
Pain scores will be recorded as reported by the patient according to NRS
- Post-operative pain assessed by Numeric Rating Scale (NRS) [2nd hour postoperatively]
Pain scores will be recorded as reported by the patient according to NRS
- Post-operative pain assessed by Numeric Rating Scale (NRS) [6th hour postoperatively]
Pain scores will be recorded as reported by the patient according to NRS
- Post-operative pain assessed by Numeric Rating Scale (NRS) [12th hour postoperatively]
Pain scores will be recorded as reported by the patient according to NRS
- Post-operative pain assessed by Numeric Rating Scale (NRS) [24th hour postoperatively]
Pain scores will be recorded as reported by the patient according to NRS
- Post-operative pain assessed by Numeric Rating Scale (NRS) [48th hour postoperatively]
Pain scores will be recorded as reported by the patient according to NRS
Secondary Outcome Measures
- Ambulation Time [72 hours post-operatively]
First time a patients can walk around independently
- Opioid Consumption [48 hour post-operatively]
Opioids(Tramadol) will be administered to patients in case demanded.
Other Outcome Measures
- Long Term Infection [Six months post-operatively]
Surgery site or prosthesis infection in six months following surgery
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients who are scheduled for primary unilateral total knee arthroplasty under spinal anesthesia
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Patients who has informed consent for study
Exclusion Criteria:
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Patient's refusal to participate
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Patients under 18 years of age
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Patients who are undergoing surgery with an anesthesia technique other than spinal anesthesia for any reason (general anesthesia, laryngeal mask application, etc.)
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Patients with known local anesthetic allergy
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Patients with Body mass index > 35
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Patients diagnosed sepsis and bacteriemia,
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Skin infection at the injection site,
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History of coagulopathy or anticoagulant therapy
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Patients with uncontrolled diabetes ,
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Uncoordinated patients,
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Psychological and emotional lability,
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Surgical intervention longer than 3 hours.
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Patients with pre-operative limitation of movement
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Izmir Bozyaka Training and Research Hospital | Karabaglar | İzmir | Turkey | 35170 |
Sponsors and Collaborators
- Bozyaka Training and Research Hospital
Investigators
- Study Director: Zeki T TEKGUL, Associate Professor, Izmir Bozyaka Training and Research Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
- Karlsen AP, Wetterslev M, Hansen SE, Hansen MS, Mathiesen O, Dahl JB. Postoperative pain treatment after total knee arthroplasty: A systematic review. PLoS One. 2017 Mar 8;12(3):e0173107. doi: 10.1371/journal.pone.0173107. eCollection 2017. Review.
- Thobhani S, Scalercio L, Elliott CE, Nossaman BD, Thomas LC, Yuratich D, Bland K, Osteen K, Patterson ME. Novel Regional Techniques for Total Knee Arthroplasty Promote Reduced Hospital Length of Stay: An Analysis of 106 Patients. Ochsner J. 2017 Fall;17(3):233-238.
- Tulgar S, Selvi O, Senturk O, Serifsoy TE, Sanel S, Meydaneri S. Evaluation of analgesic regimens in total knee arthroplasty, retrospective study. North Clin Istanb. 2017 Aug 25;4(2):124-130. doi: 10.14744/nci.2017.88598. eCollection 2017.
- DizFemoralKonsant