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Genicular Nerve Versus Adductor Canal Block for Postoperative Analgesia

NCT07588958 · Status: ACTIVE_NOT_RECRUITING · Phase: NA · Type: INTERVENTIONAL · Enrollment: 42

Last updated 2026-05-15

No results posted yet for this study

Summary

Severe postoperative pain following total knee arthroplasty (TKA ) has been shown to negatively affect early mobilization, physical rehabilitation, time to discharge, and overall post-operative recovery.Therefore, reducing postoperative pain and early mobilization has become critical in reducing early mortality, preventing future chronic pain, and limiting the use of opioids The adductor canal block (ACB) has been found to be an excellent alternative to the FNB, providing adequate analgesia to the anterior knee compartment while enabling an improved postoperative range of motion by sparing motor branches to the quadriceps muscles . However, patients do not achieve adequate posterior knee analgesia as ACB pain relief is primarily limited to the anterior capsule of the knee.

Genicular nerve block (GNB) and radiofrequency ablation of genicular nerves (RFGN) were originally introduced by Choi et al. as a therapeutic alternative for chronic knee OA and were quickly adopted for use in patients undergoing TKA due to the significant pain reduction and functional improvement observed in these patients . GNBs target five main innervating branches of the knee, including the superomedial, inferomedial, superolateral, inferolateral genicular nerves, and the infrapatellar branch of the saphenous nerve.

Conditions

  • Postoperative Pain After Total Knee Arthroplasty

Interventions

OTHER

Spinal Anesthesia with Bupivacaine and Fentanyl

spinal anesthesia will be given (under complete aseptic conditions) at the level of L3/4 while the patient in the sitting position using a spinal needle 25 G x 3.5 inches with injection of hyperbaric bupivacaine 0.5% 3ml plus fentanyl 25 microgram .

OTHER

Genicular nerve block with bupivacaine

For the superomedial genicular nerve, a linear transducer will be placed along the longitudinal plane of the femur to visualize vastus medialis, the distal femur, and the genicular artery. Using an in-plane technique, a 10-cm echogenic 21-gauge needle will be advanced in the cephalad to the caudad direction until the needle contacted femoral shaft, just cephalad to the genicular artery, and 5 ml of 0.25% bupivacaine will be injected to spread along the femoral periosteum. This same technique, using 5 ml of 0.25% bupivacaine, will be used in a mirror image on the lateral epicondyle to block the superolateral genicular nerve. To target the inferomedial genicular nerve, a linear transducer will be placed in the sagittal plane on the anterior medial tibia.

OTHER

Adductor Canal Block (ACB) Only

The transducer will be placed anteromedially midway between inguinal crease and medial condyle to identify sartorius muscle. Probe will be positioned perpendicular to the femoral artery and using in-plane technique with needle directed from lateral to medial to deposit local anesthetic under sartorius and around the femoral artery. 15ml bupivacaine 0.25% will be injected

Sponsors & Collaborators

  • Zagazig University

    lead OTHER_GOV

Principal Investigators

  • Soha Saad mohamed Hassouna, PHD · Faculty of medicine - zagazig university

Study Design

Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Model
PARALLEL

Eligibility

Min Age
65 Years
Sex
ALL
Healthy Volunteers
No

Timeline & Regulatory

Start
2023-10-01
Primary Completion
2026-05-06
Completion
2026-06-19

Countries

  • Egypt

Study Locations

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Read the full study record

This page highlights key information. For complete eligibility criteria, study locations, investigator contacts, and the full protocol, visit the original record on ClinicalTrials.gov.

View NCT07588958 on ClinicalTrials.gov