The goal of this clinical trial is to compare two different epidural analgesia delivery methods for pain control after total knee arthroplasty in adults undergoing elective surgery. The study will evaluate whether programmed intermittent epidural bolus (PIEB) provides better postoperative analgesia and recovery outcomes than continuous epidural infusion (CEI).
The main questions it aims to answer are:
Does PIEB reduce total epidural local anesthetic consumption during the first 24 postoperative hours compared with CEI? Does PIEB improve postoperative pain control and quality of recovery? Are there differences between the two methods regarding motor block, rescue analgesic requirement, patient-controlled epidural analgesia use, and adverse effects?
Researchers will compare PIEB plus patient-controlled epidural analgesia (PCEA) with CEI plus PCEA in patients undergoing total knee arthroplasty.
Participants will:
Receive combined spinal-epidural anesthesia during surgery Receive postoperative epidural analgesia using either PIEB or CEI Be evaluated for pain scores, motor block, recovery quality, epidural local anesthetic consumption, rescue analgesic requirement, and adverse events during the first 24 postoperative hours
Adults aged 18 to 80 years
American Society of Anesthesiologists (ASA) physical status I-III
Scheduled for elective primary total knee arthroplasty
Eligible for combined spinal-epidural anesthesia and postoperative epidural analgesia
Refusal to participate in the study
Known allergy or hypersensitivity to study medications
Body mass index (BMI) ≥ 40 kg/m²
Body weight < 40 kg