Comparision of IPACK and Periarticular Block With Adductor Block Alone After Total Knee Artroplasty

Not Applicable

Completed

• Conditions: Osteo Arthritis Knee
• Interventions: Procedure: block; Procedure: adductor canal block; Procedure: Adductor Canal Block plus IPACK Block; Procedure: adductor Canal Block plus PAI Block

• Registration Number: NCT04931966
• Lead Sponsor: Karaman Training and Research Hospital

Brief Summary

105 patients ASA I-III, undergoing total knee arthroplasty under spinal anesthesia, will be randomly assigned into one of three groups, namely group A (n=35), where an adductor canal block, group B (N:35) where an adductor canal block with IPCAK, and group C (n=35) where an adductor canal block with PAI will be performed preoperatively. All patients will receive a standardized multimodal approach. NRS scores will be evaluated in static and dynamic conditions during the first 48 hours postoperatively.

Detailed Description

Total knee replacement (TKP) is accepted as one of the major orthopedic surgery that most patients suffer from pain in the postoperative period. The primary aim of this research is to compare the analgesic efficacy of infiltration between the popliteal artery and capsule of the knee(IPACK) with the periarticular block when an additional adductor canal block is used. In the literature, adductor canal block(ACB) and sciatic nerve block are used as part of multimodal analgesia for postoperative pain management of patients undergoing TKP. Nevertheless, ACB is found less effective for pain originating from the posterior part of the knee. Sciatic nerve block and periarticular injection(PAI) are commonly used blocks to improve the analgesic effect of ACB. Besides this, ACB is effective for pain originated from the posterior part of the knee. IPACK block is performed under ultrasound guidance and targets the articular branches of tibial, common peroneal, and obturator nerves with sparing lower extremity motor function.

Patients scheduled for knee surgery under spinal anesthesia are included fort his study. All groups will be applied 0.03 mg/kg midazolam iv, then spinal anesthesia will be applied to 15 mg 0.5 % heavy bupivacaine. Three groups of 105 patients will be included in the study.

Adductor Canal Block (ACB) (Group A ) (n:35): After the patients are given the supine position, under the guidance of the ultrasound linear probe, 10-15cm proximal to the knee joint, under the sartorius muscle, next to the femoral artery. After the saphenous is observed, 0.25% 20 mL of bupivacaine will be given

Adductor + İPACK Grup ( group B) (n: 35): Adductor canal 0.25% 20 mL of bupivacaine will be administered. After the knee is flexed, after the convex probe is placed in the popliteal space, 20 ml of 0.25% bupivacaine will be injected into the area between the popliteal artery and the femur called IPACK

Adductor + PAI ( group C) (n: 35): Adductor canal 0.25% 20 mL of bupivacaine will be administered. Patients will receive 60 ml of local anesthetic cocktail intraoperatively by the surgeon. At the end of the operation to the peri-articular area (posterior capsule, collateral ligament, quadriceps muscle). Cocktail consists of 40 ml 0.25% bupivacaine + 8 ml 8 mg morphine+12 ml saline.

Routine multimodal analgesia will be used for postoperative analgesia

Study Timeline

• Study First Submitted: 2021-06-09
• Study First Submitted QC: 2021-06-14
• Study First Posted: 2021-06-18
• Study Start: 2021-06-22
• Status Verified: 2021-08
• Primary Completion: 2021-08-08
• Study Completion: 2021-08-17
• Last Update Submitted: 2021-08-17
• Last Update Posted: 2021-08-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 105

Inclusion Criteria

• Physical status according to American Society of Anesthesiologists (ASA) I-III
• Patients scheduled for total knee arthroplasty

Exclusion Criteria

• Previous operation on same knee
• Hepatic or renal insufficiency
• Younger than 18 years old and older than 85
• Patients undergoing general anesthesia
• Allergy or intolerance to one of the study medications
• BMI > 40
• ASA IV
• Chronic gabapentin/pregabalin use (regular use for longer than 3 months)
• Chronic opioid use (taking opioids for longer than 3 months, or daily oral morphine equivalent of >5mg/day for one month)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group A	adductor canal block	Adductor canal block
Group C	block	Adductor canal block plus PAI
Group C	adductor canal block	Adductor canal block plus PAI
Group A	block	Adductor canal block
Group B	Adductor Canal Block plus IPACK Block	Adductor canal block plus IPACK
Group C	adductor Canal Block plus PAI Block	Adductor canal block plus PAI
Group B	block	Adductor canal block plus IPACK
Group B	adductor canal block	Adductor canal block plus IPACK

Primary Outcome Measures

Name	Time	Method
NRS scores	48 hours	Numerical Rating Scale (NRS) scores (Range 0-10, 0=no pain, 10=the worse pain ever)

Secondary Outcome Measures

Name	Time	Method
Patient satisfaction	48 hours	Patients asked whether they would choose the same anaesthetic management in a future operation: Yes/No
Patient mobilization	2 days	Patient reporting time of first standing to the side of the bed and time up and go test 2 days
Range of knee motion	48 hours	Degrees of flexion
Opioid consumption	4-6-8-12-24 and 48 hours	Analgesic consumption at 4-6-8-12-24 and 48 hours
Complications	48 hours	Complications
Incidence of adverse events related to nerve block procedures	Post-op 24 to 72 hours	muscle weakness, systemic toxicity
Rate of postoperative nausea and vomiting	Post-op 24 to 48 hours	nausea, vomiting

Trial Locations

Locations (1)

Karaman Training and Research Hospital; 🇹🇷 Karaman, Turkey