IPACK Block After Total Knee Arthroplasty

Study Overview
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Brief Summary
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Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty (TKA) which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves. The hypothesis was that the combination of ACB + IPACK will provide better pain relief and improve knee function in the immediate postoperative period compared to ACB alone.

Detailed Description
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This is a prospective, randomized and double blinded study All patients received : Pregabalin 150 mg preoperatively 12 h before the surgery. Single-shot spinal anesthesia with 10 to 12 mg of bupivacaine 0.5% and 2.5ug sufentanil patients were randomly allocated to receive: Group 1: IPACK + ACB single shoot Group 2: contineous ACB For group 1: IPACK was realized after spinal anesthesia with 40 ml ropivacaine 0.2% All patients received ACB in the immediate postoperative period with 20 ml ropivacaine 0.2% Post operative analgesia included: Paracetamol 1g IV every 6 hours Diclofenac sodium (50mg) 1 tablet x 2 per day Pregabalin 150 mg given orally once daily for a period of 4 weeks. PCA morphine (Patient Controlled Analgesia), as a rescue analgesia, Continuous ACB catheter for 48H with : 4 ml per hour 0.2% ropivacaine in group 2 4 ml per hour saline in group 1

Official Title
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Comparison of Adductor Canal Block and IPACK Block With Adductor Canal Block Alone After Total Knee Arthroplasty

Conditions
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Knee Arthropathy, Postoperative Pain

Intervention / Treatment
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* Procedure: adductor canal block
* Procedure: IPACK block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: primary total knee arthroplasty under spinal anesthesia Exclusion Criteria: Contraindication or refusal to regional anesthesia Contraindication to non steroidal anti inflammatory (NSAID's) Allergy to opioids Allergy to paracetamol Creatinine clearance < 30ml/min Weight<50 kg or >100kg
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Canal adductor block<br>ACB was done in the immediate postoperative period under a high-frequency ultrasound guidance in which the adductor canal was identified beneath the sartorius muscle and 20 ml of 0.2% ropivacaine was injected in the canal using a 22-gauge 100-mm short-beveled regional block needle and a catheter was kept for 48H with 4 ml/h ropivacaine 0.2%. | Procedure: adductor canal block<br>* ACB was done in the immediate postoperative period under a high-frequency ultrasound guidance in which the adductor canal was identified beneath the sartorius muscle and 20 ml of 0.2% ropivacaine was injected in the canal using a 22-gauge 100-mm short-beveled regional block needle and a catheter was kept for 48H with 4 ml/h ropivacaine 0.2%.<br>|
| Experimental: IPACK block<br>IPACK was realized after spinal anesthesia. Patient was placed in a supine position and knee placed in position of 90° flexion. A low-frequency ultrasound probe was positioned in the popliteal crease, and the needle was inserted from medial aspect of the knee from anteromedial to posterolateral direction in a plane between the popliteal artery and the femur. The tip of the needle was placed 1-2 cm beyond the lateral edge of the artery, and 20 ml of 0.2% ropivacaine was injected for each side. A ACB was done postoperatively with 20 ml ropivacaine 0.2% and a catheter was kept for 48H with 4 ml/h saline | Procedure: adductor canal block<br>* ACB was done in the immediate postoperative period under a high-frequency ultrasound guidance in which the adductor canal was identified beneath the sartorius muscle and 20 ml of 0.2% ropivacaine was injected in the canal using a 22-gauge 100-mm short-beveled regional block needle and a catheter was kept for 48H with 4 ml/h ropivacaine 0.2%.<br>Procedure: IPACK block<br>* IPACK block was realized after spinal anesthesia with 40 ml 0.2% ropivacaine and at the end of surgery , patients were given ACB with 20 ml 0.2% ropivacaine and continued with 4 ml/H saline for 48H<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption | total Morphine consumption | Day 2 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain score at rest | numerical rating scale [0=no pain ; 10=worste pain] | Day 2 | 
| Pain score during mouvment | numerical rating scale | Day 2 [0=no pain ; 10=worste pain] | 
| Ambulation distance | number of steps walked by the patient | Day 2 | 
| Chronic pain | DN4 score [0=minimum to 10= worste score] | Month 6 | 
| functional status | KOOS PS score [0=minimum to 28= worste score] | Month 6 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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knee arthoplasty, nerve block, analgesia