Postoperative Analgesic Outcomes of iPACK Block Versus Periarticular Infiltration in Total Knee Arthroplasty: A Retrospective Cohort Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 100
- 试验地点
- 1
- 主要终点
- Postoperative Pain Score with Movement at 24 Hours
研究概览
简要总结
This study aims to retrospectively compare two different multimodal analgesic techniques for pain management after total knee arthroplasty (TKA). The primary purpose is to evaluate whether a combination of two specific nerve blocks administered by an anesthesiologist (Femoral Triangle Block + iPACK block) resulted in superior postoperative pain control compared to a hybrid combination of a nerve block and a local infiltration administered by the surgeon (FTB + Periarticular Infiltration [PAI]).
The hypothesis is that the FTB + iPACK combination is associated with a significant reduction in Numeric Rating Scale (NRS) pain scores with movement at 24 hours postoperatively. This is a retrospective, observational cohort study conducted at a single center, involving medical records of patients who underwent primary unilateral TKA. Data from patients who received either FTB + iPACK or FTB + PAI as part of their standard clinical care will be extracted and analyzed retrospectively.
详细描述
Total knee arthroplasty (TKA) is a highly successful procedure for end-stage knee osteoarthritis but is associated with significant postoperative pain. Effective pain management is crucial for facilitating early rehabilitation and improving patient comfort. Modern pain management relies on multimodal, opioid-sparing protocols that often include motor-sparing regional anesthesia techniques like the femoral triangle block (FTB).
While FTB provides excellent analgesia for the anterior part of the knee, pain originating from the posterior knee capsule remains a significant challenge. This posterior pain is commonly managed either by the surgeon through a diffuse periarticular infiltration (PAI) of a local anesthetic cocktail or by the anesthesiologist through a targeted, ultrasound-guided block of the posterior capsule known as the iPACK block.
It is currently unclear whether a fully anesthesiologist-driven, neuroanatomically targeted approach (FTB + iPACK) offers superior clinical outcomes compared to a hybrid approach involving both the anesthesiologist and the surgeon (FTB + PAI). This retrospective study is designed to compare the clinical efficacy of these two advanced analgesic combinations by reviewing institutional patient registries. All included patients had previously received a standardized spinal anesthetic (3 mL of 0.5% heavy bupivacaine) followed by either of the regional analgesia protocols. The study evaluates postoperative pain control, measured primarily by Numeric Rating Scale (NRS) pain scores at 24 hours. Secondary outcomes include total rescue analgesic (tramadol) consumption, functional recovery (Timed Up and Go test and Straight Leg Raise test), and knee range of motion.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •American Society of Anesthesiologists (ASA) physical status II-III.
- •Scheduled for elective, primary, unilateral total knee arthroplasty for osteoarthritis.
- •Able to provide written informed consent.
排除标准
- •Patient refusal to participate or contraindication to regional anesthesia.
- •Known allergy to any study medications (local anesthetics, NSAIDs, tramadol, morphine, paracetamol).
- •History of chronic opioid use (defined as daily use for >3 months)
- •Pre-existing peripheral neuropathy in the operative limb.
- •Severe renal or hepatic insufficiency.
- •Cognitive impairment preventing the use of pain scales or questionnaires.
- •Revision or bilateral knee arthroplasty.
结局指标
主要结局
Postoperative Pain Score with Movement at 24 Hours
时间窗: 24 and 48. hours postoperatively
Pain assessed via Numeric Rating Scale (NRS) during active movement (e.g., active knee flexion or straight leg raise). Scale: 0 (no pain) to 10 (worst pain imaginable).
次要结局
- Incidence of Adverse Events(First 48 hours.)
- Postoperative Pain Scores (Time-Course)(Assessed at 6, 12, and 24 hours postoperatively)
- Time to First Rescue Analgesia(First 48 postoperative hours)
- Time Up to Go Test(Assessed at 24 hours)
- Straight Leg Raise(Postoperative 24. hour)
- Knee Range of Motion (ROM)(Baseline (Preoperative) and 24 hours postoperatively)
研究者
Muhammed Celil Aslan
Anesthesiologist
Turgutlu State Hospital