Demographic data (age, gender, weight, ASA classification).The morphine dose will be repeated whenever indicated considering the total dose in the first 24 hours never exceeding 20 mg. Rescue analgesia in the form of 0.05 mg/kg of morphine IV will be administrated when the Numeric Rating Score (NRS) exceeding 3. All patients will receive postoperative analgesic regimen which is paracetamol 1gm intravenously every 8 hours and ketorolac 30mg every12 hours. All patients will receive spinal anesthesia with 3 ml 0.5% (15 mg) hyperbaric bupivacaine plus 25 μgm fentanyl at the 元/4 interspaces and the study of regional anesthetic technique will be performed postoperatively according to each group. On entering the operating room, intravenous line (IV) will be inserted, routine monitoring of heart rate by ECG, noninvasive blood pressure (NIBP), pulse oximetry will be done. During the pre-anesthetic assessment, all patients will be familiarized with Numeric Rating Scale (NRS) score. History talking, clinical examination, routine laboratory investigations including CBC, coagulation profile, random blood sugar, liver and renal function tests. Group (III): 20 patients will receive adductor canal block (ACB) and infiltration of the interspace between popliteal artery and the capsule of posterior knee block (IPACK). Group (II): 20 Patients will receive peri-articular injection alone. Group (I): 20 patients will receive adductor canal block alone. Randomization will be done by computer generated numbers into: Preexisting lower extremity neurological abnormality, or neuropathy and difficulties in comprehending (NRS).Ħ0 patients will be enrolled in this study in each group, Patients will be randomly classified into three equal groups (20 patients each).Patient with Advanced renal, hepatic and cardiac diseases.Patients with bleeding and coagulation disorders.Local infection at the site of the block.History of allergy to local anesthetics.Patient who refuse the regional anesthesia technique.Every patient will receive an explanation to the purpose of the study and every patient will have a secret code number to ensure privacy to participants and confidentiality of data.Īdult patients with severe osteoarthritis, ASA class I, II and III and scheduled for elective Total knee arthroplasty will be enrolled in the study. Any unexpected risks encountered during the course of the research will be cleared to the participants as well as to the Ethical Committee on time. All data of the patients will be confidential with secret codes and private file for each patient, all given data will be used for the current medical research only. After approval from institutional ethics committee, an informed consent will be taken from each patient. This prospective randomized study will be carried out in Tanta University Hospitals in Anesthesia Department for one year after approval from ethical committee of faculty of medicine of Tanta university. Why Should I Register and Submit Results?.
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