Genicular vs IPACK Block for Analgesia in Knee Arthroplasty

Not Applicable

Not yet recruiting

• Conditions: Postoperative Pain Management in Total Knee Arthroplasty

• Registration Number: NCT07171931
• Lead Sponsor: Kocaeli University

Brief Summary

Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures, and with the aging population, the global number of TKA cases is expected to increase sixfold within the next decade. Postoperative pain following TKA is often severe and difficult to manage, which may increase the risk of developing chronic pain. Effective pain control is therefore a major concern, and multimodal analgesia is recommended to enhance analgesia, reduce opioid consumption, and minimize opioid-related side effects.

Peripheral nerve blocks (PNBs) are an integral part of multimodal regimens. Among them, the adductor canal block (ACB), which provides analgesia to the anteromedial aspect of the knee while preserving motor function, is widely used. The optimal analgesic strategy for TKA should not only ensure adequate pain relief but also maintain quadriceps strength to allow early mobilization. Motor-sparing blocks combined with multimodal analgesia have become increasingly popular because they facilitate early rehabilitation, decrease opioid requirements, and improve recovery outcomes.

The knee joint has a complex innervation, receiving contributions from the femoral, sciatic, and obturator nerves. For this reason, combining different PNBs may provide superior analgesia compared to a single block (2). The genicular nerves, consisting of branches from the femoral, common peroneal, saphenous, tibial, and obturator nerves, innervate the knee capsule. Genicular nerve block specifically targets these branches and has been used to manage postoperative pain in TKA patients.

Another motor-sparing option is the interspace between the popliteal artery and posterior capsule of the knee (IPACK) block, which provides analgesia to the posterior aspect of the knee. Using ultrasound guidance, local anesthetic is deposited between the posterior capsule and the popliteal artery. This approach spares the main trunks of the tibial and common peroneal nerves while effectively blocking the terminal branches innervating the posterior capsule, including the genicular nerves and the popliteal plexus.

However, there are no studies in the literature directly comparing IPACK and genicular blocks. With this study, the investigators aim to compare the efficacy of these two blocks in patients undergoing TKA.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2025-08-27
• Status Verified: 2025-09
• Study First Submitted QC: 2025-09-10
• Last Update Submitted: 2025-09-10
• Study Start: 2025-09-15
• Study First Posted: 2025-09-15
• Last Update Posted: 2025-09-15
• Primary Completion: 2026-03-15
• Study Completion: 2026-04-01

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 72

Inclusion Criteria

• Patients undergoing unilateral total knee arthroplasty
• ASA physical status I-III

Exclusion Criteria

• BMI > 35
• Patients < 50 kg
• Allergy to study medications

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Morphine consumption	Postoperative day 1 (24th hour)	Amount of morphine in the postoperative period (mg)

Secondary Outcome Measures

Name	Time	Method
NRS Scores	Postoperative day 1 (1st, 6th, 12th and 24th hour)	Numeric Rating Scale scores, between 0-10 (0= no pain, 10=worst pain imaginable)
QoR-15	Postoperative 12th day	Quality of Recovery-15: 15-item questionnaire that assesses patients' overall quality of recovery, between 0-150.
Nausea-vomiting	Postoperative day 1	Number of patients who has nausea or vomiting
Rescue analgesic	Postoperative day 1	The use of rescue analgesic