Genicular Nerve Block Versus Its Combination With Infiltration Between Popliteal Artery and Capsule of Posterior Knee

Genicular Nerve Block Versus Its Combination With Infiltration Between Popliteal Artery and Capsule of Posterior Knee

Genicular Nerve Block Versus Its Combination With Infiltration Between Popliteal Artery and Capsule of Posterior Knee for Enhanced Recovery After Total Knee Arthroplasty

comparing Genicular Nerve Block with its combination with infiltration Between Popliteal Artery and Capsule of Posterior Knee for Enhanced Recovery After total Knee Arthroplasty

comparing the use of Genicular Nerve Block versus its combination with infiltration Between Popliteal Artery and Capsule of Posterior Knee as a preemptive analgesia for Enhanced Recovery After total Knee Arthroplasty

the patients will take standard analgesia (paracetamol 1 gm thrice daily and meloxicam (15 mg) every 24). ,with no nerve block

the patients will take standard analgesia plus genicular nerves block plusinfiltration Between Popliteal Artery and Capsule of Posterior Knee

In supine position with a pillow under the popliteal fossa, a 12 MHz linear transducer (XarioTM SSA-660A, Toshiba Medical Systems Corporation, Otawara, Japan) will be placed parallel to the shaft of long bones of the legs. The target points will be next to superior lateral, superior medial, and inferior medial genicular arteries to block the superior lateral, superior medial, and inferior medial branches of genicular nerve. Identification will be done using color Doppler near the periosteal areas (the junctions of the epicondyle and the shafts of the femur and tibia, accordingly). The needle will be inserted in the plane of the ultrasound probe in the long-axis view. After confirming the placement of the needle-tip next to the genicular arteries, a 2.5 mL of bupivacaine (5%) will be injected at each target points.

genicular nerve block plus infiltration Between Popliteal Artery and Capsule of Posterior Knee plus standard analgesia

IPACK block will be performed in supine position with flexion of the knee in 45o. low frequency transducer at a depth of 3.5-4 cm will be placed transversely over the medial aspect of the knee, 2-3 cm above the patella, with sliding the transducer proximally and distally to identify the distal part of the shaft of the femur and the popliteal artery ( If the two femoral condyles appear first, proximal sliding of the probe until the humps of the femoral condyles disappeared and the flat metaphysis appeared). Advance the needle in plane toward the space between the popliteal artery and the femur then 15 ml of bupivacaine 0.5% will be injected plus genicular nerve block

pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10".

pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10".

pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10".

pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10".

pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10".

pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10".

measured every 15 minutes from beginning of surgery until the end of surgery then every hour during the 1st 48 hours post operative

measured every 15 minutes from beginning of surgery until the end of surgery then every hour during the 1st 48 hours post operative

measured every 15 minutes from beginning of surgery until the end of surgery then every hour during the 1st 48 hours post operative

Inclusion criteria: Adult patients aged between 21 to 60 years undergoing primary unilateral elective total knee arthroplasty under spinal anesthesia Having informed consents patients with physical status ASA I & II both genders body mass index between 25 and 30 kg/m2. Exclusion criteria patients with Peripheral vascular disease patients with history of allergy to local anesthesia or opioid analgesia, those on anti-platelet, anticoagulant or B blocker drugs Patients with acute decompensated heart failure Patients with hypertension Patients with heart block Patients with coronary disease Patients with bronchial asthma Patients with bleeding disorders Patients with compromised renal or hepatic function pregnant female.