Comparison of Adductor Canal Block and IPACK Block Versus Adductor Canal Block and the Gastrosoleus Interfascial Plane Block for Postoperative Analgesia After Total Knee Arthroplasty: a Prospective Double Blinded Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 86
- 主要终点
- Postoperative pain using visual analogue score VAS score
研究概览
简要总结
Evaluate analgesic efficacy of adductor canal block with IPACK versus that of adductor canal block with gastrosoleus interfascial plane block in total knee arthroplasty surgeries.
详细描述
Total knee arthroplasty (TKA) is a surgical procedure commonly known for its association with sever postoperative pain. This pain can affect quality of recovery by restricting patient's ability to mobilize early and participate effectively in rehabilitation, which eventually will prolong hospital stays and increase healthcare costs. Also chronic postsurgical pain may complicate inadequately managed postsurgical pain.
Hence the need for exploring different analgesic modalities has evolved involving different techniques either regional anesthesia or systemic analgesics.
Peripheral nerve blockade was found to achieve adequate postoperative pain relief, and techniques such as sciatic nerve block, femoral nerve block and adductor canal block have been introduced.
Adductor canal block (ACB) has been shown to decrease pain significantly and thereby opioid consumption with minimal effect on quadriceps function.
Though ACB provides analgesia to the peripatellar and intra-articular aspect of knee joint, it does not relieve posterior knee pain which may compromise satisfactory pain relief.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 40 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients of ASA class I to III of both sexes
- •undergoing unilateral total knee arthroplasty
- •40-80 years old
排除标准
- •Patient refusal
- •History of coagulopathies
- •Severe renal insufficiency
- •Preexisting lower limb neurological abnormality
- •Known allergic history to any of the drugs used in this study
研究组 & 干预措施
ACB/GIP group
Adductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected.
The gastrosoleus interfascial plane block will be given along the medial border of the leg in long axis, 7 cm-8 cm below the popliteal crease. After identification of muscle bellies of the medial gastrocnemius head, the soleus and the trilaminar fascial plane between these muscles, 20 ml of bupivacaine 0.25% will be injected at this plane by piercing the fascia.
干预措施: Adductor Canal Block (ACB) + gastrosoleus interfascial plane block (Procedure)
ACB/IPACK group
Adductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected.
The patients will receive IPACK with the patient placed in a supine position and knee placed in position of 90° flexion. By placing a low-frequency ultrasound probe in the popliteal crease the spinal needle will be advanced from medial aspect of the knee going from anteromedial to posterolateral between the popliteal artery and the femur. The tip of the needle will be placed 1-2 cm beyond the lateral edge of the artery, and 20 ml of 0.25% bupivacaine will be injected.
干预措施: Adductor Canal Block (ACB) + iPACK Block (Procedure)
结局指标
主要结局
Postoperative pain using visual analogue score VAS score
时间窗: change in VAS score 30 min after arrival to PACU change in VAS score 4 hours after arrival to PACU change in VAS score 8 hours after arrival to PACU change in VAS score 12 hours after arrival to PACU change in VAS score 24 hours after arrival to PACU
• Postoperative pain using vas score where 0 is worst pain, 10 is no pain
次要结局
- Time to first morphine analgesic dose and total rescue doses of morphine.(time needed for patient to use morphine in hours after end of surgery)
- cumulative doses of morphine(cumulative doses of morphine in mg in the first 24 hours after operation)
- Range of motion by assessing degree of knee extension 24 hours after surgery.(Assessing degree of knee extension 24 hours after surgery.)
- Time of first postoperative ambulation and how many feets the patient will be able to walk.(Time of first postoperative ambulation and how many feets the patient will be able to walk in the 24 hours after operation)
- Duration of postoperative hospital stay.(Duration of postoperative hospital stay in days)
- complications of the block(complications of the block (vascular injury, nerve injury, allergic reaction) in the 24 hours after surgery)
研究者
alyaa abdel sattar mohamed hassan
lecturer
Fayoum University Hospital