GENIVS Block Versus Adductor Canal Block After Total Knee Arthroplasty

Condition(s) studied

Investigational drug(s) / intervention(s)

GENIVS block: Ultrasound-guided single-injection periosteal plane block. A linear probe is placed transversely on the medial distal thigh at or just distal to the apex of the femoral triangle and rotated about 45 degrees. The needle is advanced in-plane from medial to lateral until it contacts the anteromedial femoral periosteum beneath the vastus medialis. After bone contact is confirmed and the needle-tip position is checked with 1-2 mL of 5% dextrose, 20 mL of 0.375% bupivacaine (75 mg) is injected in 5-mL aliquots with intermittent aspiration, aiming for distal and circumferential periosteal spread.

Adductor Canal Block (ACB) Only: Ultrasound-guided single-injection adductor canal block at mid-thigh (midpoint between the inguinal ligament and the superior border of the patella). The needle is advanced in-plane from lateral to medial beneath the sartorius muscle next to the femoral artery. After the needle-tip position is checked with 1-2 mL of 5% dextrose, 20 mL of 0.375% bupivacaine (75 mg) is injected in 5-mL aliquots with intermittent aspiration so that it spreads around the artery.

Study summary

The goal of this clinical trial is to learn whether the ultrasound-guided GENIVS block is not worse than (non-inferior to) the adductor canal block in reducing opioid use after total knee arthroplasty performed under spinal anesthesia. The main question it aims to answer is:

\- Is total opioid consumption (intravenous tramadol, mg) in the first 24 hours after surgery with the GENIVS block not clinically worse than with the adductor canal block?

Researchers will also compare pain scores, time to the first analgesic request, the need for rescue pain medication, mobilization (Timed Up and Go test and stair climbing), quality of recovery (QoR-15) and opioid-related side effects between the two groups.

Participants will:

* have elective, primary, one-sided knee replacement surgery under spinal anesthesia;
* be randomly assigned to receive either a GENIVS block or an adductor canal block, with the same local anesthetic dose, at the end of surgery;
* use an intravenous tramadol patient-controlled analgesia pump and receive standard pain treatment for 72 hours;
* rate their pain and complete mobility tests and questionnaires at scheduled times during the first 72 hours after surgery.

Eligibility

Primary outcome measure(s)

• Total opioid consumption in the first 24 hours — 0 to 24 hours after PCA connection
  Total opioid consumption, measured as the cumulative intravenous tramadol dose (mg) recorded by the patient-controlled analgesia device from PCA connection (hour 0) to 24 hours.

Trial sites (1)

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