This study aims to compare the analgesic efficacy of surgeon-performed intraoperative adductor canal block (ACB) and ultrasound-guided anesthesiologist-performed ACB in patients undergoing bilateral total knee arthroplasty (TKA). In a prospective, randomized paired design, each patient will receive surgeon-performed ACB on one knee and anesthesiologist-performed ACB on the contralateral knee.
The primary outcome is postoperative pain measured using the Numeric Rating Scale (NRS), and the study is designed to evaluate the non-inferiority of surgeon-performed ACB. Secondary outcomes include opioid consumption, time to first ambulation, length of hospital stay, postoperative complications, and patient-reported outcome measures (PROMs).
Additionally, postoperative ultrasound evaluation will be performed to assess the distribution pattern of local anesthetic within the adductor canal, including cross-sectional area and longitudinal spread. This study is expected to provide evidence regarding the clinical effectiveness and technical accuracy of surgeon-performed ACB in comparison with the conventional ultrasound-guided technique.
Adult patients aged 19 years or older
Patients scheduled for bilateral total knee arthroplasty
Patients who provide written informed consent
Refusal to participate or inability to provide informed consent
Neurological or psychiatric conditions affecting cooperation (e.g., dementia, delirium)
Pre-existing neurological or anatomical abnormalities of the lower extremities
Chronic opioid use or opioid dependence
Parallel
Surgeon-Performed Adductor Canal Block
Biological/VaccineAn adductor canal block performed intraoperatively by the surgeon using an anatomical landmark-based technique. The injection is administered at approximately 8 cm proximal to the distal femur, with the needle directed medially and posteriorly. A total of 20 mL of 0.3% ropivacaine mixed with epinephrine is injected using a standardized approach without ultrasound guidance.
Ultrasound-Guided Adductor Canal Block
Biological/VaccineAn adductor canal block performed by an anesthesiologist under ultrasound guidance. The saphenous nerve and femoral artery within the adductor canal are identified using real-time imaging, and 20 mL of 0.3% ropivacaine mixed with epinephrine is injected using an in-plane technique.
Pain (Numeric Rating Scale)
Postoperative pain will be assessed using the Numeric Rating Scale (NRS, 0-10). Pain scores will be recorded at predefined time points under resting conditions. The primary analysis will evaluate the non-inferiority of surgeon-performed adductor canal block compared to ultrasound-guided adductor canal block.
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