Total knee replacement (TKR) is considered the most effective and safe method of radical treatment of late stages of knee osteoarthritis. A well-known problem of TKR is a severe postoperative pain syndrome, which is observed in more than 50% of patients.
Femoral nerve block (FNB) is the "gold standard" for continuous postoperative analgesia after total knee replacement, as it is effective in reducing the frequency of use of opioid analgetics and reduce the duration of hospitalization. At the same time, the negative effect of this method is the motor blockade of the quadriceps femoris muscle which leads to functional impairment and is associated with an increased risk of falling.
Adductor canal block (ACB) provides adequate analgesia comparable to femoral nerve block. Moreover, ACB doesn't affect the motor function of the quadriceps femoris muscle.
The possibility of enhanced recovery after total knee replacement is the reason to compare single-shot adductor canal block and continuous femoral nerve block.
Age ≥ 18
Planned primary total knee replacement
Planned neuraxial anesthesia
Written informed consent
Urgent surgery
Planned revision total knee replacement
Known allergic reaction to anesthetics
Confirmed localized infection at the puncture sites
Parallel
Single-shot adductor canal block
Procedure/SurgeryPostoperative analgesia in this group will be carried out by a single-shot bolus of 20 ml Ropivacaine 0.5% in the region of the middle third of the adductor canal.
Continuous femoral nerve block
Procedure/SurgeryPostoperative analgesia in this group will be carried out by continuous infusion of local anesthetics through a catheter installed to the femoral nerve in the area of the femoral triangle. Ropivacaine 0.2% solution will be used for postoperative analgesia. Local anesthetic infusion rate is 4 ml/h to 10 ml/h.
Ambulation distance
Less meters means worse outcome
Ambulation distance
Less meters means worse outcome
Timed up and go test
More seconds means worse outcome
Timed up and go test
More seconds means worse outcome
10 meters walk test
More seconds means worse outcome
intravascular local anesthetic injection
frequency of intravascular local anesthetic injection
neuropathy after the procedure
frequency of neuropathy after the procedure
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