This randomized, double-blind comparative study evaluates postoperative analgesic efficacy and motor effects of ultrasound-guided para-sartorial compartments (PASC) block versus ultrasound-guided combined femoral-sciatic nerve block in patients undergoing total knee arthroplasty. The primary endpoint is total nalbuphine rescue analgesia consumption in the first 24 postoperative hours. Secondary endpoints include pain scores (NRS), motor function using a modified Bromage scale, block performance characteristics, and complications.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
62
Single-shot ultrasound-guided femoral nerve block (15 milliliters of 0.25% bupivacaine) plus single-shot ultrasound-guided popliteal sciatic nerve block (15 milliliters of 0.25% bupivacaine), performed after induction of general anesthesia using sterile technique.
Single-shot ultrasound-guided para-sartorial compartments block performed after induction of general anesthesia using a single needle entry point and three injections of 0.25% bupivacaine: 10 milliliters in the femoral triangle with periarterial and subsartorial spread, 10 milliliters in the subsartorial plane at the apex of the femoral triangle, and 10 milliliters in the suprasartorial compartment at the level of the intermediate femoral cutaneous nerve (total 30 milliliters).
Ain Shams University Hospitals
Cairo, Cairo Governorate, Egypt
Total Rescue Analgesia Requirement (Nalbuphine)
Total dose of intravenous nalbuphine (in milligrams) administered as rescue analgesia when the Numeric Rating Scale pain score is 3 or higher, with a maximum daily dose of 20 milligrams.
Time frame: First 24 hours after surgery.
Postoperative Pain Intensity (Numeric Rating Scale)
Pain intensity measured using the Numeric Rating Scale (0 = no pain, 10 = worst possible pain).
Time frame: 30 minutes after admission to the post-anesthesia care unit, and 3 hours, 6 hours, 12 hours, and 24 hours after surgery.
Motor Block Assessment (Modified Bromage Scale)
Motor function assessed using the modified Bromage scale: 1 = complete block (unable to move knee or feet), 2 = almost complete (able to move feet only), 3 = partial (just able to move knees), 4 = none (full flexion of knees and feet).
Time frame: 2 hours, 4 hours, 6 hours, 12 hours, 18 hours, and 24 hours after surgery.
Block Performance Time
Time from ultrasound scanning start to completion of local anesthetic injection (in minutes).
Time frame: During block performance immediately after induction of general anesthesia.
Block Duration
Duration of sensory and motor effects of the nerve block as assessed clinically (in hours).
Time frame: Up to 24 hours after surgery.
Postoperative Nausea
Presence of postoperative nausea during the first postoperative day.
Time frame: First 24 hours after surgery.
Postoperative Vomiting
Presence of postoperative vomiting during the first postoperative day.
Time frame: First 24 hours after surgery.
Sedation (Richmond Agitation-Sedation Scale)
Richmond Agitation-Sedation Scale score ranging from +4 (combative) to -5 (unarousable); 0 indicates alert and calm.
Time frame: First 24 hours after surgery.
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