Effect of Adding Vastus Medialis Nerve Block to Adductor Canal Block After Anterior Cruciate Ligament Reconstruction (VAMA)

Effect of Adding Vastus Medialis Nerve Block to Adductor Canal Block on Postoperative Analgesia Following Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial

Anterior cruciate ligament (ACL) reconstruction is frequently associated with moderate to severe postoperative pain, which can delay mobilization and rehabilitation. The adductor canal block (ACB) is widely used for postoperative pain management because it provides effective analgesia while preserving quadriceps muscle strength. However, pain originating from the medial aspect of the knee may not be adequately controlled with ACB alone because the nerve to the vastus medialis may not be consistently anesthetized.

This prospective randomized controlled trial evaluates whether adding a vastus medialis nerve block (VMNB) to a standard adductor canal block improves postoperative pain control in patients undergoing elective arthroscopic ACL reconstruction. Participants are randomly assigned to receive either ACB alone or ACB combined with VMNB before surgery, while all patients receive the same standardized general anesthesia, surgical technique, and postoperative analgesic regimen.

The primary outcome is postoperative pain intensity measured using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours after surgery. Secondary outcomes include postoperative opioid consumption, time to first mobilization, length of hospital stay, and block-related complications. The results of this study may help determine whether the addition of a vastus medialis nerve block provides clinically meaningful benefits and may contribute to improving postoperative pain management following ACL reconstruction.

Study Overview

• Status: Completed
• Conditions: Anterior Cruciate Ligament Injury
• Intervention / Treatment: Procedure: Adductor Canal Block (ACB) Only; Procedure: Vastus Medialis Nerve Block

• Study Type: Interventional
• Enrollment (Actual): 104
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • ABD Dışında
    • Istanbul, ABD Dışında, Turkey (Türkiye), 34400
      • SBU Bagcilar Education and Training Hospital

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults aged 18 to 65 years.
• Scheduled for elective primary arthroscopic anterior cruciate ligament (ACL) reconstruction.
• American Society of Anesthesiologists (ASA) physical status I or II.
• Ability to provide written informed consent.

Exclusion Criteria:

• Previous surgery on the ipsilateral knee.
• Bilateral knee surgery.
• Coagulopathy or ongoing anticoagulant therapy contraindicating regional anesthesia.
• Peripheral neuropathy or neuromuscular disease.
• Local infection at the block injection site.
• Known allergy or hypersensitivity to amide local anesthetics.
• Contraindication to regional anesthesia.
• Refusal to participate in the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Adductor Canal Block; Participants received an ultrasound-guided adductor canal block before elective arthroscopic anterior cruciate ligament reconstruction. All participants received standardized general anesthesia and postoperative analgesic management.	Procedure: Adductor Canal Block (ACB) Only; An ultrasound-guided adductor canal block was performed before induction of general anesthesia using 15-20 mL of 0.25% bupivacaine as part of the multimodal analgesia protocol for anterior cruciate ligament reconstruction.
Active Comparator: Adductor Canal Block Plus Vastus Medialis Nerve Block; Participants received an ultrasound-guided adductor canal block combined with an ultrasound-guided vastus medialis nerve block before elective arthroscopic anterior cruciate ligament reconstruction. All participants received standardized general anesthesia and postoperative analgesic management.	Procedure: Adductor Canal Block (ACB) Only; An ultrasound-guided adductor canal block was performed before induction of general anesthesia using 15-20 mL of 0.25% bupivacaine as part of the multimodal analgesia protocol for anterior cruciate ligament reconstruction.; Procedure: Vastus Medialis Nerve Block; An ultrasound-guided vastus medialis nerve block was performed before induction of general anesthesia using 5-10 mL of 0.25% bupivacaine in addition to the adductor canal block.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pain Intensity	Postoperative pain intensity will be assessed using the 10-cm Visual Analog Scale (VAS) at rest at 1, 6, 12, and 24 hours after surgery. VAS scores range from 0 (no pain) to 10 (worst imaginable pain).	24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Opioid Consumption	Total opioid consumption during the first 24 postoperative hours will be calculated as intravenous morphine equivalent dose (mg).	24 hours after surgery
Time to First Mobilization	Time from completion of surgery to the patient's first successful ambulation, recorded in hours.	24 hours after surgery
Length of Hospital Stay	Length of postoperative hospital stay measured in hours from the end of surgery until hospital discharge.	24 hours after surgery

Collaborators and Investigators

• Sponsor: Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization

Study record dates

Study Major Dates

• Study Start (Actual): March 14, 2026
• Primary Completion (Actual): May 19, 2026
• Study Completion (Actual): June 26, 2026

Study Registration Dates

• First Submitted: June 27, 2026
• First Submitted That Met QC Criteria: June 27, 2026
• First Posted (Actual): July 6, 2026

Study Record Updates

• Last Update Posted (Actual): July 6, 2026
• Last Update Submitted That Met QC Criteria: June 27, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative Pain; Anterior Cruciate Ligament Reconstruction; Regional Anesthesia; Adductor Canal Block; Vastus Medialis Nerve Block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Wounds and Injuries; Postoperative Complications; Pathologic Processes; Leg Injuries; Knee Injuries; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Anterior Cruciate Ligament Injuries; Pain, Postoperative; Socioeconomic Factors; Population Characteristics; Demography; Family Characteristics; Marital Status; Single Person
• Other Study ID Numbers: 681433

Drug and device information, study documents

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