EFFECT OF ADDITION OF GENICULAR NERVE BLOCKS TO ADDUCTOR CANAL BLOCKS AND I-PACK BLOCKS IN TOTAL KNEE ARTHROPLASTY PATIENTS.

Phase 4

Completed

• Conditions: Medical and Surgical,

• Registration Number: CTRI/2023/07/054783
• Lead Sponsor: NORTHERN RAILWAY CENTRAL HOSPITAL

Brief Summary

Patients will be categorised into 2 groups- Group A-patients receiving Genicular nerve blocks in addition to standard Adductor canal blocks and

I-PACKS. Group B-patients receiving only adductor canal blocks(ACBs) +I-PACKS.



On the day of surgery, in all patients, routine spinal anesthesia using 12.5mg(2.5ml) hyperbaric bupivcaine will be given.After confirming the hemodynamic stability of the patients, patients in the 2 groups will undergo blocks using ultrasound as follows: All patients will receive I-PACK blocks using 15ml of 0.375% Ropivacaine and Adductor canal block catheter will be placed( infusion of 0.25% ropivacaine will be started only after the surgery at the rate of 4ml/hr).These will be placed using standard protocols.

In addition one group will receive Genicular nerve blocks using 0.5% ropivacaine( 2ml each for the superolateral, superomedial, inferomedial genicular nerves).

At the end of surgery patient will be shifted to PACU, where the continuous ACB infusion will be started.

A standardised protocol of oral paracetamol 650mg 6hourly and injection diclofenac 50mg will be given 12hourly.

Those patients who reported pain score(NRS> EQUAL TO 4) will be randomised to receive rescue analgesia which will be one of the following- morphine 10mg=buprenorphine 0.4mg=butorphanol 2mg=nalbuphine 10 mg.

At the end of 24hrs, total rescue analgesia given will be calculated in morphine equivalents.

Detailed Description

Not available

Study Timeline

• Study Start: 2023-07-20
• Last Update Posted: 2025-04-04

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 58

Inclusion Criteria

ASA GRADE 1-3 BMI-18 TO 35 KG/M2 SCHEDULED FOR PRIMARY TOTAL KNEE ARTHROPLASTY SURGERY.

Exclusion Criteria

Known allergy or intolerance to ropivacaine , bupivacaine or other local anaesthetics Contraindication to peripheral nerve block(eg- local infection, neurologic deficit or disorder, previous trauma or surgery of ipsilateral knee, etc.) Any history of chronic pain Chronic opioid consumption(daily morphine equivalent of >30 mg for at least four weeks prior to surgery) Receiving general anaesthesia Hepatic or renal insufficiency History of psychiatric disorder History of Epilepsy or Seizure disorder significant coagulopathy (platelet count <75000/ml or international normalized ratio >1.5) Revision surgery.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Total morphine equivalents given to the patient over and above the standard pain analgesia protocol in patients undergoing total knee replacement surgery.	24 hours

Trial Locations

Locations (1)

NORTHERN RAILWAY CENTRAL HOSPITAL; 🇮🇳 Central, DELHI, India

NORTHERN RAILWAY CENTRAL HOSPITAL

🇮🇳Central, DELHI, India

DR SONAXI DAS

Principal investigator

8249477429

sonaxidas11@gmail.com