"The Effect of Adductor Canal Block Performed With Postoperative Thigh Tourniquet Application on Pain After Total Knee Arthroplasty"

Обзор

The biggest fear for patients undergoing knee replacement surgery is that persistent pain felt at the back of the knee postoperatively. While regional anesthesia is generally successful at numbing the front of the knee, managing pain in the posterior (back) area is not always easy. In this study, we tested a new method designed to alleviate pain in the back of the knee and improve patient comfort.

Подробное описание

A New Solution for "Posterior" Pain After Knee Surgery To ensure patient comfort following knee replacement surgery, we routinely use ultrasound-guided injections of local anesthetics around the nerves of the knee to block pain signals. While this method is highly successful at eliminating pain in the anterior (front) part of the knee, studies have shown that the medication often fails to reach the deep posterior (back) compartments, leaving patients with persistent discomfort in that area.

In this study, we addressed a fundamental question: "How can we ensure the medication reaches those hard-to-access depths at the very back of the knee?"

To achieve this, we developed a simple yet highly effective technique. We applied a tourniquet-similar to a blood pressure cuff-to the upper leg and inflated it for a short period. We administered the medication, then released the tourniquet and performed a second application.

This controlled pressure on the upper leg acted as a barrier, preventing the anesthetic from migrating upward toward the groin and instead "pushing" it into the narrow passages at the back of the knee. By doing so, we enabled the medication to reach deep points that it typically cannot access on its own.

The Results:

As a result of this technique, we observed a significant reduction in stubborn posterior knee pain. Furthermore, our patients required substantially fewer potent painkillers (analgesics) during their recovery.

Вмешательства

• Процедура Tourniquet-Assisted Adductor Canal Block (T-ACB) grou
  Participants received an ultrasound-guided distal adductor canal block. The procedure was performed in two stages: First, a pneumatic tourniquet placed on the proximal thigh was inflated for 3-5 minutes (at a pressure of approximately 142-202 mmHg), during which 20 mL of 0.25% bupivacaine was injected. Subsequently, the tourniquet was deflated, and an additional 20 mL of 0.25% bupivacaine was administered, reaching a total volume of 40 mL. This technique aimed to enhance the distribution of the
• Процедура Standard Adductor Canal Block (S-ACB)
  Participants received a standard ultrasound-guided distal adductor canal block. During the procedure, 20 mL of 0.25% bupivacaine was injected in a single dose without any tourniquet modification or additional pressure application. The technique relied on the natural, passive, and anatomical distribution of the local anesthetic within the adductor canal.

Первичные конечные точки

• This method aims to alleviate posterior knee pain and decrease overall VAS scores [Срок оценки: At 3, 8, 12, and 24 hours post-block]

Вторичные конечные точки (1)

• To decrease cumulative opioid requirements and facilitate mobilization while preserving muscle strength [Срок оценки: at 3,8,12,24. post-block hours]

Критерии участия

Inclusion Criteria Patients aged 40-85 years, with a BMI of 18-35 kg/m², and an ASA physical status of I-III who underwent total knee arthroplasty (TKA) under spinal anesthesia were included. Eligible participants were those who volunteered to participate and provided written informed consent.

Критерии исключения

To ensure methodological standardization, the following cases were excluded:

Patients undergoing revision surgery.

Those undergoing unicompartmental (unicondylar) knee replacement, as the severity of surgical trauma differs from total replacement.

Bilateral cases, to prevent potential bias in assessing postoperative opioid consumption and pain scores.

Additionally, patients were excluded if:

The surgical duration exceeded 180 minutes.

There was a known history of coagulopathy, peripheral neuropathy, or allergy to local anesthetics.

The spinal anesthesia was insufficient, requiring a conversion to general anesthesia.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Нерандомизированное

Модель

Одна группа

Маскирование

Простое слепое

Основная цель

Поддерживающая терапия

Центры проведения

Turkey (Türkiye) · 1 центр

• Ankara Etlik Şehir Hastanesi — Ankara

Публикации

• Sonawane K, Dixit H, Mistry T, Gurumoorthi P, Balavenkatasubramanian J. Anatomical and Technical Considerations of the Hi-PAC (Hi-Volume Proximal Adductor Canal) Block: A Novel Motor-Sparing Regional Analgesia Technique for Below-Knee Surgeries. Cureus. 2022 Feb 6;14(2):e21953. doi: 10.7759/cureus.21953. eCollection 2022 Feb. PMID 35282508

Идентификаторы

NCT: NCT07539467 · AEŞH-EK-2025-245

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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