COMPARISON OF THE EFFECT OF DISTAL ADDUCTOR CANAL BLOCK COMBINED WITH GENICULAR NERVE BLOCK OR PERIARTICULAR INJECTION ON POSTOPERATIVE QOR-15 IN TOTAL KNEE ARTHROPLASTIES

COMPARISON OF THE EFFECT OF DISTAL ADDUCTOR CANAL BLOCK COMBINED WITH GENICULAR NERVE BLOCK OR PERIARTICULAR INJECTION ON POSTOPERATIVE QOR-15 IN TOTAL KNEE ARTHROPLASTIES: A RANDOMIZED CONTROLLED STUDY

Objective: This study compares the effects of genicular nerve block (GNB) and periarticular injection (PAI), added to distal adductor canal block (ACB), on postoperative recovery quality (QoR-15), morphine use, and pain scores after total knee arthroplasty (TKA).

Methods: Sixty patients received spinal anesthesia and distal ACB, then were randomized to GNB (Group G, n=30) or PAI (Group P, n=30). QoR-15, morphine consumption, VAS pain scores, nausea/vomiting, and side effects were evaluated.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Recovery
• Intervention / Treatment: Procedure: genicular nerve block; Procedure: Addukctor canal block; Procedure: Spinal Anesthesia with Bupivacaine and Morphine; Procedure: periarticular injection

Detailed Description

Objective: Total knee arthroplasty (TKA) is a common surgical procedure for knee pathologies of various etiologies, where postoperative pain management is critical for early mobilization and rehabilitation. Different blockade techniques targeting the femoral, obturator, and sciatic nerves, which provide sensory innervation to the knee, are evaluated in terms of analgesic efficacy and preservation of motor function. The adductor canal block (ACB) targets the saphenous nerve without affecting motor function, whereas periarticular injection (PAI) and genicular nerve block (GNB) provide more comprehensive analgesia by blocking other branches of the femoral nerve as well as the obturator and sciatic nerves. This study aims to compare the effects of GNB and PAI, applied in addition to distal ACB, on postoperative recovery quality measured by the Quality of Recovery-15 (QoR-15) score, morphine consumption, and pain scores in patients undergoing TKA.

Materials and Methods: This single-center, randomized, prospective study included patients over 18 years of age with ASA physical status I-III who were scheduled for total knee arthroplasty under spinal anesthesia. All patients received spinal anesthesia with 15 mg isobaric bupivacaine combined with 100 mcg intrathecal morphine. Additionally, all patients underwent ultrasound-guided distal adductor canal block. Patients were randomized into Group G (n=30) and Group P (n=30). Group G received preoperative genicular nerve block (5+5+5 ml of 0.25% bupivacaine), whereas Group P received intraoperative periarticular injection administered by the surgical team, consisting of 8 mg morphine, 40 mg methylprednisolone, 0.3 mg adrenaline, 750 mg cefazolin and 110 mg bupivacaine. The primary outcome measure was the quality of recovery evaluated by the Quality of Recovery-15 (QoR-15) questionnaire at 24 hours postoperatively. Secondary outcomes included morphine consumption at 2., 6., 12. and 24 hours postoperatively, resting and movement Visual Analog Scale (VAS) pain scores, postoperative nausea and vomiting (PONV) scores, and the incidence of adverse effects such as respiratory depression, urinary retention, and pruritus.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • İstanbul, Turkey
    • Bezmialem Vakıf Universitesi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Patients scheduled for knee arthroplasty
• Patients classified as ASA I, II, or III
• Patients aged 18 years and older

Exclusion Criteria:

• Patients with a known allergy to any of the drugs used in the study
• Presence of infection near the puncture site
• History or presence of neurological disorders (e.g., transient ischemic attack, syncope, dementia, etc.)
• Known coagulation disorders
• History of alcohol or substance abuse
• Impaired consciousness
• Chronic opioid use equal to or exceeding 60 mg of oral morphine equivalents per day
• Pre-existing neuropathic pain
• Hepatic failure, renal failure, or cardiac insufficiency
• Uncontrolled diabetes mellitus
• Pregnant or breastfeeding women
• Refusal or inability to provide written informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Grup G; Genicular nerve block	Procedure: genicular nerve block; genicular nerve block with a total of 15 mL of 0.25% bupivacaine preoperatively; Procedure: Addukctor canal block; Addukctor canal block with 15ml %0.25 bupivacaine; Procedure: Spinal Anesthesia with Bupivacaine and Morphine; Spinal Anesthesia with Bupivacaine(isobaris 15-18mg) and Morphine(100mcg)
Active Comparator: Grup P; Periarticular injecrion	Procedure: Addukctor canal block; Addukctor canal block with 15ml %0.25 bupivacaine; Procedure: Spinal Anesthesia with Bupivacaine and Morphine; Spinal Anesthesia with Bupivacaine(isobaris 15-18mg) and Morphine(100mcg); Procedure: periarticular injection; periarticular injection prepared by the surgical team containing 8 mg morphine, 40 mg methylprednisolone, 0.3 mg adrenaline, 750 mg cefazolin, and 110 mg bupivacaine.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative 24th hour qor-15	Postoperative 24th hour qor-15 score	Postoperative 24th hour

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative 2nd, 6th, 12th, and 24th hour morphine consumption	Postoperative 2nd, 6th, 12th, and 24th hour morphine consumption	Postoperative 2nd, 6th, 12th, and 24th hour
Postoperative 2nd, 6th, 12th, and 24th hour resting VAS score	Postoperative 2nd, 6th, 12th, and 24th hour resting VAS score	Postoperative 2nd, 6th, 12th, and 24th hour
Postoperative 2nd, 6th, 12th, and 24th hour movement VAS score	Postoperative 2nd, 6th, 12th, and 24th hour movement VAS score	Postoperative 2nd, 6th, 12th, and 24th hour
Postoperative 2nd, 6th, 12th, and 24th hour adverse effects	Postoperative 2nd, 6th, 12th, and 24th hour adverse effects	Postoperative 2nd, 6th, 12th, and 24th hour

Collaborators and Investigators

• Sponsor: Bezmialem Vakif University

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2025
• Primary Completion (Actual): June 15, 2025
• Study Completion (Actual): July 3, 2025

Study Registration Dates

• First Submitted: July 1, 2025
• First Submitted That Met QC Criteria: July 12, 2025
• First Posted (Actual): July 22, 2025

Study Record Updates

• Last Update Posted (Actual): July 22, 2025
• Last Update Submitted That Met QC Criteria: July 12, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Total Knee Arthroplasty; QoR-15; periarticular injection; Genicular nerve bloc
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pain, Postoperative; Physiological Effects of Drugs; Peripheral Nervous System Agents; Anesthetics, Local; Anesthetics; Central Nervous System Depressants; Sensory System Agents; Analgesics; Analgesics, Opioid; Narcotics; Bupivacaine; Morphine
• Other Study ID Numbers: 29.01.2025-E.180706

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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