This is a single-center, prospective, randomized controlled trial aiming to evaluate the effects of different regional anesthesia/analgesia techniques on postoperative knee range of motion (ROM) and patient satisfaction following total knee arthroplasty (TKA). Ninety patients undergoing elective TKA under spinal anesthesia will be randomly assigned to one of three groups: 1) spinal anesthesia with epidural catheter, 2) spinal anesthesia followed by adductor canal catheterization, and 3) spinal anesthesia with multimodal intravenous analgesia. The primary outcome is postoperative knee joint ROM measured on postoperative days 1, 2, and 3. Secondary outcomes include patient satisfaction, Oxford Knee Score, postoperative opioid consumption, and VAS scores. The study is conducted at Konya City Hospital and will be completed over a 6-month period.
Minimum Age: 18 Years
Maximum Age: None
Sex: All
Gender Based: No
Skin infection at the planned injection site
Sepsis
Coagulopathy
Refusal of neuraxial anesthesia
Parallel
Regional anethesia
Procedure/SurgeryThis single-center, prospective, randomized controlled trial aims to compare the effects of three different postoperative analgesia techniques following spinal anesthesia in patients undergoing total knee arthroplasty (TKA). The study will assess the impact of combined spinal-epidural anesthesia, adductor canal block, and multimodal intravenous analgesia on postoperative knee range of motion (ROM). Secondary outcomes include patient satisfaction, opioid consumption, Oxford Knee Score (OKS), activity levels, and visual analog scale (VAS) pain scores.
Postoperative Knee Range of Motion (ROM)
Knee joint flexion and extension range of motion will be measured using a standard goniometer by a blinded assessor. Measurements will be performed with the patient in a supine position, ensuring standardized positioning for all participants.
Total Opioid Consumption
Cumulative opioid consumption (intravenous and oral) will be recorded and converted to morphine milligram equivalents (MME).
Oxford Knee Score (OKS)
Oxford Knee Score (OKS) questionnaire: Functional outcome will be evaluated using the Oxford Knee Score, a validated 12-item questionnaire assessing pain and physical function.To assess knee pain and functional ability from the patient's perspective. Number of questions: 12 Score range: 0 to 48 Interpretation: 0 points = worst possible outcome (severe pain and poor function) 48 points = best possible outcome (no pain and full function) Direction: Higher scores indicate better outcomes
Visual Analog Scale (VAS) Pain Score
Pain intensity at rest and during movement will be assessed using a 10-cm visual analog scale (0 = no pain, 10 = worst possible pain).
Incidence of Adverse Events Related to Anesthesia or Analgesia
The occurrence of anesthesia- or analgesia-related complications (e.g., motor weakness, sensory deficits, infection at catheter site, nausea/vomiting, hypotension) will be recorded.
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