Total Knee Arthroplasty patients are among the orthopedic cases that experience severe postoperative pain. In these cases, pain must be controlled. If pain is not controlled, early mobilization cannot be achieved. This can result in delayed physical therapy, prolonged hospital stays, the development of nosocomial infections, and impaired cognitive function. All of these factors contribute to increased patient care costs. Multimodal analgesia methods are used to control this pain. One of these methods is peripheral nerve blocks. Peripheral nerve blocks provide pain control and reduce the likelihood of opioid use and related side effects such as nausea, vomiting, and constipation. Current studies recommend Adductor Canal Blocks and iPACK (space between the popliteal artery and the posterior knee capsule) blocks for Total Knee Arthroplasty patients. In addition, studies are also being conducted on the application of the Suprainguinal Fascia-Iliaca Block in Total Knee Arthroplasty patients. The differences in postoperative analgesic effects between these methods are a matter of interest. No study has been conducted comparing the effects of these two approaches, which are routinely applied in our clinic and comply with guidelines, on the postoperative stress response. Regional anesthesia provides adequate pain control and has a positive effect on the stress response. The investigators aim to see a similar effect in peripheral nerve blocks. Therefore, comparing the methods that mentioned will contribute to the literature. In this study, the effects of these two different approaches on postoperative stress response and analgesic efficacy will be compared in terms of patients' postoperative opioid consumption, pain at rest and with movement, time to first analgesic need and development of motor block. IL-6 and CRP values will be examined pre-operatively and post-operatively to measure the effects on the stress response.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
52
Ultrasound Guided Suprainguinal Fascia Iliaca Block, 30 ml Bupivacain %0,25
Ultrasound Guided Adductor Canal Block, 15ml Bupivacain %0,25
Ultrasound Guided iPACK Block, 15ml Bupivacain %0,25
SB Istanbul Education and Research Hospital
Istanbul, Turkey (Türkiye)
RECRUITINGCumulative opioid consumption
Tramadol consumption will be recorded for 24 hours.
Time frame: 24 hours
Numeric rating scale for pain
Variations in the Numeric Rating Scale (NRS) scores, both at rest and during movement, will be documented at specific time points (End of the surgery, Post-operative 6th, 12th and 24th hour). The NRS is a simple, single-dimensional tool used to assess pain intensity in adult patients. It is a numeric adaptation of the Visual Analog Scale (VAS), where individuals are asked to choose an integer between 0 and 10 that best represents their pain level. A score of '0' corresponds to "no pain," while '10' indicates the "worst imaginable pain" or "pain as severe as possible.
Time frame: Up to 24 hours
Time to first postoperative analgesic requirement
The time to first postoperative analgesic requirement was recorded.
Time frame: Up to 24 hours
Postoperative quadriceps muscle strength
Muscle strength assessment will be performed using the Modified Bromage Scale. (End of the surgery, Post-operative 6th, 12th and 24th hour) Grade 0: No motor block; the patient is able to fully flex the hip and knee. Grade 1: Partial motor block; the patient is able to move the knee and foot but is unable to lift the extended leg. Grade 2: Nearly complete motor block; the patient is unable to flex the knee and can only move the foot. Grade 3: Complete motor block; the patient is unable to move the ankle or the great toe.
Time frame: Up to 24 hours
Incidence of postoperative nausea and vomiting
Opioid side effects were recorded.
Time frame: Up to 24 hours
Quality of Recovery 15 (QoR-15)
The influence of surgical and anesthetic interventions on perioperative quality of life and the patient's ability to return to routine daily activities will be systematically evaluated. QoR-15 has 15 questions. Each question is answered on a scale of 1 to 10. A higher score indicates more positive outcomes.
Time frame: 24 hours
Inflammatory marker levels
The levels of inflammatory biomarkers (interleukin-6, CRP, NLR \[Neutrophil-Lymphocyte Ratio\], PLR \[Platelet-Lymphocyte Ratio\]) will be assessed prior to surgery and at 24 hours postoperatively.
Time frame: Up to 24 hours
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.