Comparision of IPACK and Periarticular Block With Adductor Block Alone After Total Knee Artroplasty
Condition: Osteo Arthritis Knee
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

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
    

Intervention name(s): block; adductor canal block; Adductor Canal Block plus IPACK Block; adductor Canal Block plus PAI Block
Intervention type(s): Procedure; Procedure; Procedure; Procedure
Intervention description(s): Adductor canal block; adductor canal block bupivacain; Adductor Canal Block plus IPACK Block using bupivacaine; Adductor Canal Block plus PAI Block using bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Total knee arthroplasty; Peri articular infiltration; Ipack block; Adductor canal block