الفهرس 
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Abstract
T
otal knee arthroplasty (TKA) is one of the most commonly performed operations in our daily practice. It is indicated in all patients with severe osteoarthritis and it needs early postoperative ambulation to improve postoperative outcomes and to reduce immobility related complications. Providing adequate analgesic control is very important to achieve functional recovery, facilitates rehabilitation and attenuates the progression from acute to chronic postsurgical pain, aiming to maximize non-opioid analgesics in addition to regional analgesic techniques. It is estimated that the majority of patients experience either severe pain (60% of patients) or moderate pain (30% of patients) following TKA surgeries. With the emergence of enhanced recovery after surgery ERAS clinical pathways, many surgical specialties are adopting multimodal analgesic regimens to improve patient outcomes.
Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuraxial or peripheral nerve blocks were employed. An ideal nerve block that targets the sensory nerves and spares the motor function, can facilitate early ambulation and rehabilitation, which is a major goal for patients undergoing total knee replacement
Femoral nerve block is known to provide superior pain control and shortens the time of functional recovery and the length of hospital stay without associated side effects, in comparison with epidural or intravenous patient-controlled analgesia. However, it reduces quadriceps muscle strength and results in an increased risk of falls. Saphenous nerve block in the adductor canal finds the balance between optimal analgesia and minimal motor weakness and it continues to be an active area of research. it produces a primarily sensory block.
There is a growing importance to the application of the ultrasound in clinical practice of anesthesia and regional nerve block. The idea of pre-emptively scanning patient’s anatomy for neurovascular variations or abnormalities has been suggested as a means of improving patient safety by preventing block complications such as hematoma formation, improper block or intravascular injection.
In our study we performed a prospective randomized trial to compare between ultrasound guided femoral nerve block FNB versus ultrasound guided saphenous nerve block (adductor canal block ACB) regarding postoperative Quadriceps muscle strength, ambulation ability and postoperative analgesic efficacy. Postoperative Quadriceps muscle strength clinical testing by conducting a straight leg test with grading the motor power and ambulation ability assessment by a Timed Up-and-Go test (TUG test) at 24 hours postoperative. Postoperative analgesic efficacy in terms of pain scores using numerical rating scoring NRS at 30 min after PACU admission, 3hr, 6hr, 12hr & 24hr postoperatively. Also, total Nalbuphine consumption, as a rescue analgesic drug, was calculated in the first 24 hours postoperatively.
We found that Straight leg raising percentages were significantly higher in saphenous group compared to femoral group and TUG test results were lower in saphenous nerve block group compared to FNB group, showing a statistically significant difference in quadriceps muscle strength being higher in in saphenous/adductor canal block group than femoral nerve block group.
As regard analgesic efficacy in both groups, NRS pain scores and cumulative 1st 24 hours Nalbuphine consumption were equivalent.