ESPB and ACB in Knee Arthroplasty

Comparison of the Effects of Ultrasound-Guided Erector Spinae Plane Block and Adductor Canal Block on Postoperative Pain, Opioid Consumption and Quadriceps Muscle Strength in Total Knee Arthroplasty Surgery

Total knee arthroplasty surgery is preferred in the treatment of osteoarthritis and causes severe postoperative pain. In this study, we aimed to investigate the effects of lumbar erector spina plan block and adductor canal block on postoperative pain and quadriceps muscle strength in patients who underwent total knee arthroplasty with spinal anesthesia.

Study Overview

• Status: Completed
• Conditions: Post Operative Pain
• Intervention / Treatment: Procedure: Erector Spinae Plane Block; Procedure: Adductor Canal Block

Detailed Description

In a prospective, randomized study; Medeniyet University Faculty of Medicine Göztepe Prof. Dr. Forty patients who underwent total knee arthroplasty surgery at Süleyman Yalçın City Hospital were divided into two groups. After the surgery was completed, erector spina plane block was applied to Group E (n=20) patients with 20 ml of 0.25% bupivacaine from the operated side L3-L4 level, while in Group A (n=20) patients, in the area where the sartorius muscle crosses the adductor magnus muscle, it was lateral to the superficial femoral artery. Adductor canal block was applied to the adductor canal with 20 ml of 0.5% bupivacaine. All patients were administered 1 gr paracetamol and 75 mg diclofenac sodium when their pain started in the orthopedic ward. Numerical pain score and quadriceps muscle strength were evaluated during the 48-hour follow-up of the patients. When the pain score was 4 and above, 50 mg pethidine hydrochloride was administered.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • Istanbul Medeniyet University Goztepe Suleyman Yalcın City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• patients who underwent total knee arthroplasty surgery
• ASA I-III patients

Exclusion Criteria:

• Patients with coagulopathy
• Patients history with local anesthetic allergy or toxicity
• Patients with long hospital stay
• Patients with advanced organ failure
• Mental retarded patients
• Presence of infection at the injection site

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Erector Spinae Plane Block; Erector Spina Plane Block was performed to the patients after coplition of total knee arthroplasty operation for postopetaive pain.	Procedure: Erector Spinae Plane Block; After the necessary asepsis and antisepsis procedures, the linear ultrasound probe was placed parasagittally 2-3 cm lateral to the spinous process at the L3 or L4 level and the transverse process was visualized. The peripheral block needle (85 mm B Braun Stimuplex A) was advanced in plane up to the transverse process and 10 ml 0.5% bupivacaine hydrochloride 10 ml 0.9% isotonic NaCl mixture was applied on the erector spina muscle.
Active Comparator: Adductor Canal Block; Adductor Canal Block was performed to the patients after coplition of total knee arthroplasty operation for postopetaive pain.	Procedure: Adductor Canal Block; After the necessary asepsis and antisepsis procedures, the linear ultrasound probe was placed in the middle between the medial condyle and the SIAS, and the superficial femoral artery (FSA) was visualized under the sartorius muscle. By following the FSA distally, the point where the sartorius muscle crosses the adductor magnus muscle, which is the beginning of the adductor canal, was found and the saphenous nerve was visualized hyperechoic in the anterolateral aspect of the FSA. 20 cc 0.5% bupivacaine hydrochloride was applied

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain 30 minute	Visual anolog score (1-10)	30. min.
Postoperative pain 1. hour	Visual anolog score (1-10)	1. hour
Postoperative pain 2. hour	Visual anolog score (1-10)	2. hour
Postoperative pain 6. hour	Visual anolog score (1-10)	6. hour
Postoperative pain 12. hour	Visual anolog score (1-10)	12. hour
Postoperative pain 24. hour	Visual anolog score (1-10)	24. hour
Postoperative pain 36. hour	Visual anolog score (1-10)	36. hour
Postoperative pain 48. hour	Visual anolog score (1-10)	48. hour

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Opioid consuption 30. min.	Petidine (mg)	30. min.
Opioid consuption 1. hour	Petidine (mg)	1. hour
Opioid consuption 2. hour	Petidine (mg)	2. hour
Opioid consuption 6. hour	Petidine (mg)	6. hour
Opioid consuption 12. hour	Petidine (mg)	12. hour
Opioid consuption 24. hour	Petidine (mg)	24. hour
Opioid consuption 36. hour	Petidine (mg)	36. hour
Opioid consuption 48. hour	Petidine (mg)	48. hour

Collaborators and Investigators

• Sponsor: Istanbul Medeniyet University

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2021
• Primary Completion (Actual): June 15, 2022
• Study Completion (Actual): August 30, 2022

Study Registration Dates

• First Submitted: October 6, 2022
• First Submitted That Met QC Criteria: November 10, 2022
• First Posted (Actual): November 14, 2022

Study Record Updates

• Last Update Posted (Actual): November 14, 2022
• Last Update Submitted That Met QC Criteria: November 10, 2022
• Last Verified: November 1, 2022

More Information

Terms related to this study

• Keywords: Total Knee Arthroplasty; Adductor Canal Block; Erector Spinae Plane Block
• Additional Relevant MeSH Terms: Pathologic Processes; Postoperative Complications; Pain; Neurologic Manifestations; Pain, Postoperative
• Other Study ID Numbers: IstanbulMUG

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No