the goal of this clinical trial is to compare the efficacy of adductor magnus muscle plane injection as an approach for sciatic nerve block to sub-gluteal approach in combination with femoral nerve blocks as perioperative analgesia in knee surgeries.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
In the supine position, the femoral nerve block will be conducted using a high-frequency ultrasound probe to identify the femoral nerve just below the fascia iliaca. After proper sterilization, the needle will be advanced in-plane to inject 15 ml bupivacaine 0.5% around the nerve. After performing the femoral nerve block, the adductor magnus muscle plane block will be performed using a low-frequency ultrasound probe positioned 6 cm distal to the inguinal crease to identify the sartorius muscle, femoral artery, femoral vein, and femoral nerve on the deep side of the sartorius muscle, the probe will be slide by about 2-2.5 cm distally, where we could identify the plane between the adductor magnus and the semimembranosus muscles, and after proper sterilization, the needle will be slowly advanced until the needle tip is close to the posterior surface of the AMM, 20 mL of bupivacaine 0.5% will be injected while observing fluid distribution under the posterior surface of the AMM, Then GA.
While the patient is in the supine position, the femoral nerve block will be conducted using a high-frequency ultrasound probe to identify a cross-sectional view of the femoral nerve just below the fascia iliaca. After proper sterilization, the needle will be advanced in-plane to inject 15 ml bupivacaine 0.5% around the nerve. the patient will be turned on their sides with the operative side uppermost and flexed, the sub-gluteal sciatic nerve will be identified using a low-frequency probe, and then the same needle will be advanced the in-plane to inject 20 ml bupivacaine 0.5% around the nerve., then GA will be conducted as the other group
Faculity of medicine - Al-Azhar University hospitals
Cairo, Cairo Governorate, Egypt
Assessment of sciatic sensory block
It will be assessed by evaluating the sharp sensation with pinprick testing, and the presence or loss of cold-warm feeling as (2 for normal sensory perception, 1 for loss of cold-warm feeling, and 0 for loss of pinprick sensation) for ciatic in the sole of foot.
Time frame: At 30 minutes after the block
Assessment of sciatic motor block
Sciatic block will be evaluated by the motion of the foot and ankle joint (3 for normal movement, 2 for unable to push or flex the foot against external resistance, 1 for unable to push or flex the foot against gravity and 0 for no motion
Time frame: At 30 minutes after the block
Postoperative pain scores
Using the Visual Analog Scale (VAS)
Time frame: At 1, 6, 12, and 24 hours post-operative
The onset of sciatic sensory blockades
Time in minutes from removing of the local anesthesia needle to the start of sensory changes
Time frame: Every 3 minutes with maximum time 30 minutes (if no changes within 30 min the patient will be excluded from the study)
The duration of the sciatic nerve block procedure
the time in minutes from the start of the sonographic examination for the sciatic nerve block until local anaesthetic administration.
Time frame: during sciatic nerve block conduction
Visibility scores for the sciatic nerve
using a 6-point visibility scale: 0: No nerve was identified 1. Nerve identified with a high probability 2. Nerve identified but most of it was not visible 3. Nerve identified and more than 50% of its borders were precisely distinguished from the surrounding structures 4. Nerve completely visible but fascicles poorly defined 5. Nerve completely visible and multiple fascicles identifiable
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Time frame: during sciatic nerve block using sub gluteal approach conduction
Visibility scores for Adductor magnus muscle (AMM)
using a 6-point visibility scale for AMM: 0: No muscle was identified 1. Muscle identified with a high probability 2. Muscle identified but most of it was not visible 3. Muscle identified and more than 50% of its epimysium were precisely distinguished from the surrounding structures 4. Muscle completely visible but perimysium poorly defined 5. Muscle completely visible and multiple perimysium identifiable
Time frame: during sciatic nerve block using adductor magnus muscle plain block conduction
Patient satisfaction
Using 4 degrees scale: excellent, good, sufficient, insufficient
Time frame: Before the patient discharge
The onset of the Sciatic motor block
Time in minutes from removing of the local anesthesia needle to the start of motor changes
Time frame: Every 3 minutes with maximum time 30 minutes (if no changes within 30 min the patient will be excluded from the study)