Objective:
Evaluation of Genicular Nerve Block for Postoperative Pain Management of Anterior Cruciate Ligament Reconstruction Surgery.
Study design: a single blind randomized clinical trial
Inclusion criteria:
Patients aged 16-70 years with ASA 3-1 who suffer from anterior cruciate ligament (ACL) injury and who are candidates for rehabilitation and repair of the anterior cruciate ligament and have the ability to collaborate and answer to the study questions.
Exclusion criteria :
Patients with femoral and sciatica neuropathy; coagulopathy; infection in the blockade side ; Pregnancy; Chronic use of opium over 3 months; contraindication for regional anesthesia; allergy to the used drugs; renal or hepatic failure; uncontrolled epilepsy; contraindication for general anesthesia; severe anxiety and depression.
Intervention:
50 patients will be randomly assigned to the one of the two groups of (B) or (S). local block procedure will have performed after induction of anesthesia and before surgery. Three genicular nerves: medial superior genicular nerves , medial inferior genicular nerve, lateral superior genicular nerves are diagnosed by the ultrasound sonography device , by using the Spinal needle gauge 22 patients’ knee will be blocked with 5 ml of Marcaine 0.5% added to 25 macro gram -epinephrine in group B while, 5 cc normal saline will be injected in the patients’ knee (in the control group = group S ).
The severity of the pain in the recovery room will be evaluated every 15 minutes by the NRS.
The time of the first demand for postoperative analgesics and total morphine consumption will be recorded. In the ward, an PCA pump will used with 0.5 mg / ml of morphine. Patient's pain in the first 24 hours after surgery will be measured at 2, 4, 6, 8, 12, 16, 20, and 24 with the NRS(Numerical Rating Scale).
In case of NRS above 4 despite the use of PCA pump, pain will controlled based on the provided protocol in the recovery room .
total morphine consumption will be recorded within the first 24 hours after the operation.
Morphine-induced complications such as itching, nausea and vomiting, urinary retention, respiratory depression and sleepiness (based on the Wilson criteria) will be recorded at 4, 8, 12, 16, 20 and 24 hours after the operation.