Comparison of Pain Score Between Femoral Triangle Block plus Proximal Adductor Canal Block and Proximal Adductor Canal Block Alone under Ultrasound-Guided in Patients undergoing Unilateral Total Knee Arthroplasty, A Prospective Randomized Controlled Trial Study

INTERVENTION: Experimental Procedure/Surgery,Experimental Procedure/Surgery Femoral triangle block was done at 1 to 2 cm above the The ape Xof the femoral triangle, bounded by the inguinal ligament above, the satorreous muscle on the outside, and on the inside on the adductor longus muscle, and was administered 10 mL of 0.125% bupuvacaine lateral to the femoral artery. Proximal adductor canal block means injection local anesthetic agent in the adductor canal, which is 1 to 2 cm from the ape Xof the femoral triangle by using 0.125% bupivacaine 20 ml.,Proximal adductor canal block means injection local anesthetic agent in the adductor canal, which is 1 to 2 cm from the ape Xof the femoral triangle by using 0.125% bupivacaine 30 ml. Proximal adductor canal block and Femoral triangle block,Proximal adductor canal block PRIMARY OUTCOME: Pain score 0, 2, 4, 8, 12 ,18 ,24 hours after surgery Numeric rating scale SECONDARY OUTCOME: morphine consumption 0, 2, 4, 8, 12 ,18 ,24 hours after surgery milligram,Timing to receive intravenous analgesic drug first time to receive analgesic drug minute,hospital stay patient discharge hours,complication 0, 2, 4, 8, 12 ,18 ,24 hours after surgery questionnaire interview yes no INCLUSION CRITERIA: 1.A patient undergo unilateral total knee arthroplasty under spinal anesthesia at Chomthong Hospital Chiang Mai During 2023 to December 2024 2.Age is more than 18 years old 3.ASA (American society of anesthesiologist) status are I,I,III 4.A patient can cooperate in research CONDITION: Nowadays, the number of aging population is increasing all over the world. Osteoarthritis of the knee (OA knee) is a chronic disease that can be found in the elderly and is a major public health problem. Chronic pain in OA knee caused stiff knee joint that affected the daily activities, work and quality of life of the patient. One method for treatment of OA knee is total knee arthroplasty. It is a common orthopedic surgery that is increasing every year around the world. It is predicted that future knee osteoarthritis surgeries will increase by 143% from 2012 to 20501. Total knee arthroplasty is the operation that causes moderate to severe pain especially 24 hours after opreration2. Inadequate pain control results in chronic pain which can be found in total kness arthroplasty 20%2,3. Pain can be occurred delayed physical therapy and recovery4 and caused complications after surgery, resulting in increasing length of stay in the hospital. In addition, inadequate pain control leads to inappropriate using of opioid that caused complications from opioid such as nausea and vomiting, itching of the skin or respiratory depression. Therefore, effective pain control can early rehabilitation, less complications from pain and opioid and reduced hospital stay.5 Chomthong Hospital tends to increase unilateral TKA every year because the Thai population increases with the average age so there will be more chances of OA knee. Number of unilateral knee replacement surgery in Chomthong hospital in 2019 to 2021 was 130, 150, and 170 that increasing averaged 15‐25% per year.Using spinal anesthesia plus proximal adductor canal block plus Local infiltration anesthesia. from a surgeon can control pain well But there was still pain in the anterior knee and inner part of the upper thigh, which was inadequate pain control resulting in delayed recovery, Longer hospital stays. Therefore, added femoral triangle block can reduce pain in the anterior knee and inner thigh. ; total knee arthropl total knee arthroplasty, OA knee, Proximal adductor canal block, Femoral triangle block, Pain score, morphine consumption