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Comparison of Anterior Sciatic Nerve Block and Adductor Magnus Muscle Plane Block for Anterior Cruciate Ligament Surgery

15. mai 2026 oppdatert av: Ahmet Murat Yayik, Ataturk University

Comparison of Anterior Sciatic Nerve Block and Adductor Magnus Muscle Plane Block Added to Adductor Canal Block in Patients Undergoing Anterior Cruciate Ligament Surgery

Anterior cruciate ligament (ACL) reconstruction is frequently associated with moderate-to-severe postoperative pain despite its arthroscopic nature, owing to the complex sensory innervation of the knee involving the femoral, sciatic, and obturator nerves. Multimodal analgesic strategies, particularly peripheral nerve blocks, are therefore widely used to improve postoperative pain control and reduce opioid consumption. Although anterior sciatic nerve block can be combined with adductor canal block in the supine position, its application may be technically challenging because of the deep localization of the sciatic nerve. Recently, adductor magnus muscle plane block has emerged as a potentially easier alternative by indirectly targeting the terminal branches of the sciatic nerve through fascial plane spread. In this study, we compared the efficacy of anterior sciatic nerve block and adductor magnus muscle plane block, both combined with adductor canal block.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

This single-center, prospective, randomized clinical trial included 90 patients aged 18-45 years with ASA physical status I-II who underwent arthroscopic anterior cruciate ligament reconstruction under spinal anesthesia. Patients were randomly allocated into three groups to receive either adductor canal block alone (Group C), adductor canal block combined with anterior sciatic nerve block (Group ASB), or adductor canal block combined with adductor magnus muscle plane block (Group AMB). Randomization was performed using a computer-generated sequence with concealed allocation through sealed opaque envelopes. Although the anesthesiologist performing the blocks was aware of group allocation, all postoperative assessments were conducted by an independent blinded investigator. All regional blocks were ultrasound-guided and performed preoperatively by the same experienced anesthesiologist using standardized techniques and local anesthetic volumes. Procedural characteristics, including block performance time, needle visibility, needle passes, and sonographic visibility of target structures, were systematically recorded. Sensory blockade was assessed at predefined intervals using cold-warm discrimination tests across multiple nerve distributions.

All patients received standardized spinal anesthesia with hyperbaric bupivacaine, as well as a multimodal postoperative analgesic regimen including intravenous paracetamol, dexketoprofen, and fentanyl-based patient-controlled analgesia. Postoperative pain scores at rest and during movement were evaluated at multiple time points during the first 24 hours, while cumulative fentanyl consumption, time to first PCA demand, and rescue analgesic requirements were recorded. Opioid-related adverse events, including nausea, vomiting, constipation, pruritus, dry mouth, and urinary retention, were also documented. In addition, postoperative motor function of the tibialis anterior and quadriceps femoris muscles was assessed using a three-point qualitative motor scale at predefined postoperative intervals up to 48 hours.

Studietype

Intervensjonell

Registrering (Faktiske)

90

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Voksen

Tar imot friske frivillige

Nei

Beskrivelse

Inclusion Criteria:

  • Anesthesiologists (ASA) physical status I-II,
  • Scheduled for arthroscopic anterior cruciate ligament reconstruction

Exclusion Criteria:

  • cardiovascular disease,
  • hepatic dysfunction,
  • coagulopathy or current use of anticoagulant therapy,
  • inability to cooperate,
  • known allergy to any of the study medications,
  • refusal to participate in the study

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Dobbelt

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Aktiv komparator: Adductor Canal Block
Participants in this arm will receive an ultrasound-guided adductor canal block using 20 mL of 0.25% bupivacaine. Blocks will be performed under sterile ultrasound guidance by an experienced anesthesiologist who will not participate in postoperative assessments. All patients will receive standardized spinal anesthesia and perioperative analgesia.
Fremgangsmåte: Adductor canal block
Ultrasound transducer was placed perpendicular to the thigh to visualize the sartorius muscle, femoral artery and vein, and the adductor canal. Following infiltration of the skin and subcutaneous tissue with 2% lidocaine, a 22-gauge, 10-cm echogenic needle was advanced in-plane from lateral to medial toward the adductor canal. After confirming correct needle tip placement with 2 mL of 0.9% NaCl solution, 20 mL of 0.25% bupivacaine was administered.
Andre navn:
  • ACB
Aktiv komparator: Adductor Canal + Anterior Sciatic nerve block
Participants in this arm will receive an ultrasound-guided anterior sciatic nerve block (20 mL of 0.25% bupivacaine) and adductor canal block (20 mL of 0.25% bupivacaine). Blocks will be performed under sterile ultrasound guidance by an experienced anesthesiologist who will not participate in postoperative assessments. All patients will receive standardized spinal anesthesia and perioperative analgesia.
Fremgangsmåte: Adductor canal block
Ultrasound transducer was placed perpendicular to the thigh to visualize the sartorius muscle, femoral artery and vein, and the adductor canal. Following infiltration of the skin and subcutaneous tissue with 2% lidocaine, a 22-gauge, 10-cm echogenic needle was advanced in-plane from lateral to medial toward the adductor canal. After confirming correct needle tip placement with 2 mL of 0.9% NaCl solution, 20 mL of 0.25% bupivacaine was administered.
Andre navn:
  • ACB
Fremgangsmåte: Anterior sciatic nerve block
An ultrasound transducer was placed perpendicular to the anterior thigh. The sartorius muscle, femoral artery and vein, adductor longus muscle, adductor magnus muscle, and the sciatic nerve were identified. Following infiltration of the skin and subcutaneous tissue with 2% lidocaine, a 22-gauge, 10-cm echogenic needle was advanced toward the sciatic nerve under ultrasound guidance. Nerve stimulation was applied, and an appropriate motor response in the sciatic nerve distribution was obtained at 0.2-0.5 mA. After injection of 2 mL of 0.9% saline and visualization of perineural spread to confirm correct needle placement, 20 mL of 0.25% bupivacaine was administered.
Andre navn:
  • ASB
Aktiv komparator: Adductor Canal + Adductor magnus plane block
Participants in this arm will receive an ultrasound-guided adductor magnus plane block (20 mL of 0.25% bupivacaine) and an adductor canal block (20 mL of 0.25% bupivacaine). Blocks will be performed under sterile ultrasound guidance by an experienced anesthesiologist who will not participate in postoperative assessments. All patients will receive standardized spinal anesthesia and perioperative analgesia.
Fremgangsmåte: Adductor canal block
Ultrasound transducer was placed perpendicular to the thigh to visualize the sartorius muscle, femoral artery and vein, and the adductor canal. Following infiltration of the skin and subcutaneous tissue with 2% lidocaine, a 22-gauge, 10-cm echogenic needle was advanced in-plane from lateral to medial toward the adductor canal. After confirming correct needle tip placement with 2 mL of 0.9% NaCl solution, 20 mL of 0.25% bupivacaine was administered.
Andre navn:
  • ACB
Fremgangsmåte: Adductor magnus plane block
An ultrasound transducer was placed perpendicular to the thigh to visualise the sartorius muscle, femoral artery and vein, adductor longus, and the underlying adductor magnus muscle. Following infiltration of the skin and subcutaneous tissue with 2% lidocaine, a 22-gauge, 10-cm echogenic needle was advanced until the posterior fascia of the adductor magnus muscle was penetrated. After injection of 2 mL of 0.9% NaCl solution, correct needle placement was confirmed by observing fluid spread beneath the posterior surface of the adductor magnus muscle. Subsequently, 20 mL of 0.25% bupivacaine was administered.
Andre navn:
  • AMB

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Opioid consumption
Tidsramme: 0-4 hours, 4-8 hours, 8-24 hours, Total 24-hour
Postoperative opioid consumption
0-4 hours, 4-8 hours, 8-24 hours, Total 24-hour

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Pain Scores (VAS) at Rest and During Movement
Tidsramme: PACU, 1st hour, 2nd hours, 4th hours, 8th hours, 12th hours, 24th hours
Pain intensity will be evaluated using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst pain). Assessments will be performed at rest and during movement at predefined postoperative time points.
PACU, 1st hour, 2nd hours, 4th hours, 8th hours, 12th hours, 24th hours
Adverse Effects
Tidsramme: up to 24 hours
Opioid-Related Adverse Effects
up to 24 hours
Evaluation of Nerve Blockade after Nerve Block Application
Tidsramme: 5., 10., 15., 20., 30., and 45. minutes

Post-block sensory assessment was performed at predefined time intervals using a cold-warm discrimination test.

Sensory evaluation was conducted at the plantar surface of the foot for the tibial nerve, the dorsal surface of the foot for the superficial peroneal nerve, the posterolateral aspect of the leg for the sural nerve, the posterior aspect of the thigh for the posterior femoral cutaneous nerve, and at the medial malleolus for the saphenous nerve.
5., 10., 15., 20., 30., and 45. minutes
Quadriceps and Anterior Tibialis Muscle Strength
Tidsramme: 4th hours, 8th hours, 12th hours, 24th hours, 48th hours
Muscle strength will be assessed using standardized manual muscle testing (paralysis/paresis/normal) for quadriceps and anterior tibialis muscles.
4th hours, 8th hours, 12th hours, 24th hours, 48th hours

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Ataturk University

Etterforskere

  • Studiestol: Samet Kapakin, Professor, Ataturk University

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

1. april 2024

Primær fullføring (Faktiske)

1. mars 2026

Studiet fullført (Faktiske)

1. april 2026

Datoer for studieregistrering

Først innsendt

11. mai 2026

Først innsendt som oppfylte QC-kriteriene

15. mai 2026

Først lagt ut (Faktiske)

22. mai 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

22. mai 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

15. mai 2026

Sist bekreftet

1. mai 2026

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Andre studie-ID-numre

  • B.30.2.ATA.0.01.00/761

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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