Regional Anesthesia in TKA: Impact on Postoperative Joint Motion and Patient Satisfaction

Konya City Hospital30 enrolled

Overview

This is a single-center, prospective, randomized controlled trial aiming to evaluate the effects of different regional anesthesia/analgesia techniques on postoperative knee range of motion (ROM) and patient satisfaction following total knee arthroplasty (TKA). Ninety patients undergoing elective TKA under spinal anesthesia will be randomly assigned to one of three groups: 1) spinal anesthesia with epidural catheter, 2) spinal anesthesia followed by adductor canal catheterization, and 3) spinal anesthesia with multimodal intravenous analgesia. The primary outcome is postoperative knee joint ROM measured on postoperative days 1, 2, and 3. Secondary outcomes include patient satisfaction, Oxford Knee Score, postoperative opioid consumption, and VAS scores. The study is conducted at Konya City Hospital and will be completed over a 6-month period.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Total Knee Arthroplasty Postoperative Pain Regional Anesthesia

Interventions

Regional anethesiaPROCEDURE

This single-center, prospective, randomized controlled trial aims to compare the effects of three different postoperative analgesia techniques following spinal anesthesia in patients undergoing total knee arthroplasty (TKA). The study will assess the impact of combined spinal-epidural anesthesia, adductor canal block, and multimodal intravenous analgesia on postoperative knee range of motion (ROM). Secondary outcomes include patient satisfaction, opioid consumption, Oxford Knee Score (OKS), activity levels, and visual analog scale (VAS) pain scores.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

* Minimum Age: 18 Years * Maximum Age: None * Sex: All * Gender Based: No * Accepts Healthy Volunteers: No * Inclusion Criteria: * Scheduled for primary total knee arthroplasty * Age ≥ 18 years * American Society of Anesthesiologists (ASA) physical status I-III * Accepting neuraxial anesthesia * Exclusion Criteria: * Skin infection at the planned injection site * Sepsis * Coagulopathy * Refusal of neuraxial anesthesia * Severe hypovolemia * Demyelinating central nervous system disease * Age under 18 years * Illiterate in Turkish * Non-cooperative patients * Known allergy or hypersensitivity to bupivacaine

Outcomes

Primary Outcomes

Postoperative Knee Range of Motion (ROM)

Knee joint flexion and extension range of motion will be measured using a standard goniometer by a blinded assessor. Measurements will be performed with the patient in a supine position, ensuring standardized positioning for all participants.

Time frame: Postoperative day 1, day 3, day 7, and day 90 after surgery.

Secondary Outcomes

Total Opioid Consumption

Cumulative opioid consumption (intravenous and oral) will be recorded and converted to morphine milligram equivalents (MME).

Time frame: From the end of surgery to 72 hours postoperatively.

Oxford Knee Score (OKS)

Oxford Knee Score (OKS) questionnaire: Functional outcome will be evaluated using the Oxford Knee Score, a validated 12-item questionnaire assessing pain and physical function.To assess knee pain and functional ability from the patient's perspective. Number of questions: 12 Score range: 0 to 48 Interpretation: 0 points = worst possible outcome (severe pain and poor function) 48 points = best possible outcome (no pain and full function) Direction: Higher scores indicate better outcomes

Time frame: Preoperatively (baseline) and postoperative day 90.

Visual Analog Scale (VAS) Pain Score

Pain intensity at rest and during movement will be assessed using a 10-cm visual analog scale (0 = no pain, 10 = worst possible pain).

Time frame: Postoperative day 1, day 3, and day 7 after surgery.

Incidence of Adverse Events Related to Anesthesia or Analgesia

The occurrence of anesthesia- or analgesia-related complications (e.g., motor weakness, sensory deficits, infection at catheter site, nausea/vomiting, hypotension) will be recorded.

Time frame: Intraoperative period and up to 90 days postoperatively.

Patient Satisfaction Score

Patient satisfaction with postoperative analgesia will be assessed using a 5-point Likert scale (1 = very dissatisfied, 5 = very satisfied).

Time frame: Postoperative day 3 and day 90 after surgery.