Comparison Between Combined Biceps Femoris Short Head Block and Adductor Canal Block Versus Genicular Nerve Block

Condition(s) studied

Investigational drug(s) / intervention(s)

Combined biceps femoris short head block and adductor canal block: Adductor Canal Block high-frequency probe will be placed transversely on the anterior thigh midpoint between inguinal crease and medial condyle (depth 3-5 cm). The needle will be advanced in-plane from lateral to medial through sartorius or vastus medialis muscle toward the femoral artery. Then (10 ml of 0.25% bupivacaine and 2 mg dexamethasone) will be injected after negative aspiration, with confirming spread around the artery without vascular puncture. Biceps femoris short head block The probe will be placed on the distal posterior thigh to visualize biceps femoris muscle near the lateral supracondylar line of the femur. The needle will be inserted to the interface between biceps femoris and femur cortex. Then (25 ml of 0.25% bupivacaine and 2 mg dexamethasone), with observing muscle lift and circumferential spread along the bone surface .

Genicular nerve block: Position the patient will be placed in supine position with the knee slightly flexed via a pillow in the popliteal fossa. Use a high-frequency linear ultrasound transducer. Superolateral genicular nerve (SLGN): the transducer will be placed coronally over lateral femoral epicondyle, with sliding proximally to femur metaphysis; identifying artery between vastus lateralis fascia and bone. Superomedial genicular nerve (SMGN): the transducer will be placed coronally over medial femoral epicondyle, proximal to adductor tubercle at femur metaphysis; artery between vastus medialis fascia and bone. Inferomedial genicular nerve (IMGN): the transducer will be placed coronally over medial tibial condyle, distal to metaphysis; artery beneath medial collateral ligament. • Inferolateral genicular nerve (ILGN, optional): the transducer will be placed coronally over lateral tibial epicondyle to fibula head; artery between collateral ligament and tibia

Study summary

The purpose of this study is to compare the analgesic outcomes (time to first analgesic request, total amount of analgesic consumption, and pain scores) following total knee arthroplasty by either combined biceps femoris short head block and adductor canal block or genicular nerve block in elderly patients.

Eligibility

Primary outcome measure(s)

• Time of first rescue analgesia (naluphine) — 24 hours postoperative
  to the duration from the block to the moment when the patient first requires or requests supplemental nalbuphine due to breakthrough pain

Trial sites (1)

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