Adductor Canal Block With Periarticular Injection and IPACK (ACB/PAI/IPACK) Versus Periarticular Injection (PAI)
Condition: Knee Arthropathy
MeSH terms: Joint Diseases
Study type: Interventional
Phase: Phase 4

Summary: 
      A comparison of two pain control methods - the combination of Adductor Canal Block
      (ACB)/Periarticular Injection (PAI)/Infiltration of the interspace between the popliteal
      artery and the capsule of the posterior knee (IPACK) versus the Periarticular Injection (PAI)
      - in patients undergoing total knee arthroplasty. Primary outcome is NRS pain scores with
      ambulation on postoperative day one (24 hours post-block administration).
    

Detailed description: 
      Total knee arthroplasties (TKA) are severely painful surgeries that require optimal pain
      control to ensure expeditious recovery and discharge. Nerve blocks, such as the femoral and
      sciatic nerves, are instrumental in effectively providing pain relief and improving patient
      satisfaction. However, though pain scores notably decreased with the introduction of nerve
      blocks, motor blockade rendered these patients immobile and may pose a fall risk early in the
      post-operative period. The advent of ultrasound introduces newer block techniques with
      adequate analgesia without the cost of motor blockade.

      The adductor canal block serves as an alternative to the femoral or sciatic nerve blocks in
      providing anterior knee analgesia without significantly compromising quadriceps strength.
      However, patients' posterior knee compartment remains an issue for pain control. Sciatic and
      posterior tibial nerve blocks were implemented but again, results in motor blockade. A small
      percentage of sciatic nerve block cases also exhibit foot drop due to peroneal nerve injury.
      Alternatively, as a sensory block, the periarticular injection (PAI) proves to hasten
      ambulation and recovery after TKA. The PAI blind injection into the posterior capsule seems
      to aid in pain control of the posterior compartment and reduces the total number physical
      therapy sessions.

      Injection in the interspace between the Popliteal Artery and Capsule of the posterior Knee
      (IPACK) provides an alternative to the PAI blind technique for analgesia in the posterior
      compartment. The IPACK block is not a nerve block, but rather infiltrates the area between
      the popliteal artery and femur. This area is rich with sensory nerve fibers from the
      posterior capsule of the knee, which originates from the sciatic and posterior tibial nerve.
      In this prospective study, we will compare pain scores between the three groups:
      ACB/PAI/IPACK, ACB/IPACK and PAI only. We will determine whether there is a difference
      between groups in NRS pain score with ambulation 24 hours post block administration.
    

Intervention name(s): Bupivacaine with epinephrine; Methylprednisolone; Cefazolin; 8 MHz. Chiba needle; Bupivacaine with Dexamethasone; Bupivacaine 25cc; Bupivacaine 20cc; Dexamethasone
Intervention type(s): Drug; Drug; Drug; Device; Drug; Drug; Drug; Drug
Intervention description(s): bupivacaine 0.5% with epinephrine 30cc; 40 mg/ml, 1 ml; 500 mg in 10 ml; 22G/ 4 inches; 15 cc of bupivacaine 0.25% with 2 mg of PF Dexamethasone; 25 cc 0.25% bupivacaine; 20cc 0.25% bupivacaine; 2 mg IV dexamethasone.
Other intervention name(s): Sensorcaine/Epinephrine, Sensorcaine-MPF/Epinephrine, Marcaine-Epinephrine (PF); Depo-Medrol, Solu-Medrol, Medrol; cephalosporin antibiotics; dexamethasone to non-liposomal bupivacaine; Exparel, Marcaine, Marcaine Spinal (PF); Exparel, Marcaine, Marcaine Spinal (PF); Ozurdex, Maxidex, DexPak 6 Day
Intervention MeSH terms: Cefazolin; Cephalosporins; Dexamethasone; Dexamethasone acetate; Methylprednisolone; Methylprednisolone Acetate; Methylprednisolone Hemisuccinate; Epinephrine; Racepinephrine; Bupivacaine; Epinephryl borate; BB 1101
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: IPACK; PAI