Investigation of the Effect of Proximal and Distal Adductor Canal Block in Knee Replacement Surgery

Investigation of the Effect of Proximal and Distal Adductor Canal Block on Pain Control and Functional Mobility in Total Knee Prosthesis Surgery Performed Under Spinal Anesthesia

to investigate the effect of adductor canal block applied with two different approaches in the treatment of pain after TKA surgery on pain control and functional mobility.

Study Overview

• Status: Recruiting
• Conditions: Knee Osteoarthritis
• Intervention / Treatment: Other: ADDUKTOR CANAL BLOCK; Other: CONTROL GROUP

Detailed Description

This prospective randomized trial is randomly divided into 3 groups using the method. Total knee arthroplasty is performed by the same surgical team.

is applied. The patients were divided into proximal ACB applied, distal ACB applied and control groups.

• Study Type: Interventional
• Enrollment (Estimated): 78
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zeliha TUNCEL; Phone Number: +90 505 357 74 83; Email: zelihalara@yahoo.com

Study Locations

• Turkey (Türkiye)
  • Umraniye
    • Istanbul, Umraniye, Turkey (Türkiye), 34734
      • Recruiting
      • Umraniye Education and Research Hospital
      • Contact: ZELİHA TUNCEL, ass prof; Phone Number: 5053577483; Email: zelihalara@yahoo.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Medications for unilateral TKA surgery

  • Patients aged 18-85
  • ASA 1-3

Exclusion Criteria:

• Patients under 18 years of age and over 85 years of age
• Patients with ASA 4 and above
• Patients with cognitive impairment
• Patients with application site infection
• Patients allergic to local anesthesia
• Patients receiving anticoagulant therapy
• Patients with bleeding diathesis
• Patients with chronic opioid or substance use
• Patients with insulin-dependent diabetes mellitus

• patients with neuropathy

  • patients with hepatic or renal failure
• Patients who do not accept the procedure to be applied

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: PROXİMAL ADDUKTOR CANAL BLOCK GROUP; Patients are placed in the supine position and a high-frequency linear probe is inserted for a cross-sectional image of the groin and thigh. The femoral nerve is identified in the short axis near the inguinal crease and the ultrasound transducer is placed caudally beyond the femoral triangle. The location of the proximal block is determined where the superficial femoral artery passes under the medial border of the sartorius muscle (usually 8-12 cm distal to the inguinal crease). Using the in-plane technique, a 100 mm peripheral nerve block needle is advanced until the tip of the needle passes the sartorius muscle and enters the adductor canal from the lateral side of the superficial femoral artery, and 20 mL 0.375% Bupivacaine is administered. To verify block success, sensory function is assessed by pinprick testing along the saphenous nerve distribution by comparing the pinprick sensation to the unaffected limb.	Other: ADDUKTOR CANAL BLOCK; All patients who will undergo adductor canal block are sedated with midazolam 0.03 mg/kg in the preoperative preparation room, after standard monitoring. After 2-3 ml skin infiltration with 2% lidocaine under sterile conditions, a block is applied under USG guidance.To verify block success, sensory function is assessed by pinprick testing along the saphenous nerve distribution by comparing the pinprick sensation to the unaffected limb.All patients are monitored in the operating room and in a sitting position, 10-20 mg (2-4 ml) of heavy marcaine (0.5% bupivacaine hydrochloride and dextrose monohydrate) is applied to the subarachnoid space by entering the L3-4 or L4-5 space with a 25-gauge Whitrace needle.For postoperative multimodal analgesia, which is routinely applied to all patients, intravenous PCA (patient controlled analgesia )tramadol and paracetamol 10 mg / kg iv (8 hours apart) will be given.
Active Comparator: DİSTAL ADDUKTOR CANAL BLOCK GROUP; Patients are placed in the supine position, the mid-thigh point is determined as half the distance between the groin crease and the top of the patella. After the mid-thigh mark is marked with a sterile marking pen, the ultrasound transducer is positioned for a transverse view of the adductor canal into the mid-thigh. Under USG imaging, the femoral artery and saphenous nerve are identified. The distal position is determined where the USG probe moves away from the sartorius muscle of the femoral artery and proceeds deep into the adductor hiatus, and a 100 mm block needle passes the sartorius muscle with an in plane technique and 20 mL 0.375% Bupivacaine is administered to the lateral side of the femoral artery and saphenous nerve.	Other: ADDUKTOR CANAL BLOCK; All patients who will undergo adductor canal block are sedated with midazolam 0.03 mg/kg in the preoperative preparation room, after standard monitoring. After 2-3 ml skin infiltration with 2% lidocaine under sterile conditions, a block is applied under USG guidance.To verify block success, sensory function is assessed by pinprick testing along the saphenous nerve distribution by comparing the pinprick sensation to the unaffected limb.All patients are monitored in the operating room and in a sitting position, 10-20 mg (2-4 ml) of heavy marcaine (0.5% bupivacaine hydrochloride and dextrose monohydrate) is applied to the subarachnoid space by entering the L3-4 or L4-5 space with a 25-gauge Whitrace needle.For postoperative multimodal analgesia, which is routinely applied to all patients, intravenous PCA (patient controlled analgesia )tramadol and paracetamol 10 mg / kg iv (8 hours apart) will be given.
Sham Comparator: CONTROL GROUP; No nerve block procedure is applied to patients.	Other: CONTROL GROUP; No nerve block procedure is applied to patients.All patients are monitored in the operating room and in a sitting position, 10-20 mg (2-4 ml) of heavy marcaine (0.5% bupivacaine hydrochloride and dextrose monohydrate) is applied to the subarachnoid space by entering the L3-4 or L4-5 space with a 25-gauge Whitrace needle.For postoperative multimodal analgesia, which is routinely applied to all patients, intravenous PCA (patient controlled analgesia) tramadol 50 mg at 10 mg / hour basal rate after loading (20 mg bolus dose + 30 minutes lock time) and paracetamol 10 mg / kg iv (8 hours apart) will be given.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
VISUAL ANALOGUE SCALE(VAS)	VAS pain score was evaluated as "no pain" (score=0) and "worst pain" (score=10) and was divided into 3 groups according to the World Health Organization's pain intensity scale: score <3 mild pain, 3-6 mild-moderate. degree pain and >6 moderate-severe pain.	POSTOPERATIVE 6, 12 AND 24 HOURS

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
first mobilization time	The first postoperative mobilization hours of the patients will be recorded.	within postoperative 24 hours
length of hospital stay	The time between patients' admission and discharge will be recorded.	ONE WEEK
opioid use	Intravenous PCA will be applied to each patient and the total tramadol dose spent will be calculated.intravenous PCA (patient controlled analgesia) tramadol 50 mg at 10 mg / hour basal rate after loading (20 mg bolus dose + 30 minutes lock time)	within postoperative 24 hours

Collaborators and Investigators

• Sponsor: Umraniye Education and Research Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 10, 2023
• Primary Completion (Estimated): February 27, 2026
• Study Completion (Estimated): March 30, 2026

Study Registration Dates

• First Submitted: December 18, 2023
• First Submitted That Met QC Criteria: December 18, 2023
• First Posted (Actual): January 3, 2024

Study Record Updates

• Last Update Posted (Actual): November 19, 2025
• Last Update Submitted That Met QC Criteria: November 16, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: adduktor canal block,knee artroplasti,postoperative pain
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Postoperative Complications; Pathologic Processes; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Osteoarthritis, Knee; Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: URH-AR-ZT-06

Drug and device information, study documents

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