Adductor Canal Block Combined With IPACK vs Genicular Nerves Block in Knee Arthroscopy

Study Overview
=================
Brief Summary
-----------------
This prospective randomized controlled study is designed to investigate the postoperative analgesic effect of adductor canal block (ACB) combined with infiltration of the interspace between the popliteal artery and the capsule of posterior knee (IPACK) block compared to genicular nerves block in patients undergoing knee arthroscopy.

Detailed Description
-----------------
Maintaining patient safety, ensuring best patient outcomes, and optimal pain relief post-operatively are of utmost concern for anesthesia providers. Adequate pain relief attenuates stress responses and long-term chronic pain complications while contributing to improved postoperative outcomes. Knee arthroscopy is a very common procedure and very often is performed as day-case surgery. Ambulatory arthroscopic surgery of the knee is preferred by the majority of properly selected and well-informed patients. It has been reported that a significant number of patients have moderate to severe pain 24 hours after ambulatory surgery in general and knee arthroscopy in particular and pain affects the patient's activity level and satisfaction. Adductor canal block (ACB) is a popular peripheral nerve block that has been shown to decrease the pain significantly and decrease opioid consumption with minimal effect on quadriceps function. It provides analgesia to the peri-articular and intra-articular aspects of the knee joint but doesn't relieve posterior knee pain which is moderate to severe in intensity.

Official Title
-----------------
Analgesic Effect of Adductor Canal Block Combined With Infiltration of the Interspace Between Popliteal Artery and the Capsule of the Knee (IPACK) Block Versus Genicular Nerves Block in Knee Arthroscopy

Conditions
-----------------
Arthroscopy, Genicular Nerves Block

Intervention / Treatment
-----------------
* Procedure: Spinal anesthesia only
* Biological: Spinal anesthesia and ultrasound-guided Genicular nerves block
* Biological: Ultrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age 21-60 years Both genders American Society of Anaesthesiologists physical status classification I - III Patients scheduled for elective unilateral knee arthroscopy under spinal anesthesia Exclusion Criteria: Patient refusal Preoperative neurological deficits Opioid-dependent (opioid intake more than 3 months) Chronic pain conditions Significant cardiac and respiratory disease Pre-existing major organ dysfunction such as hepatic and renal failure Coexisting hematological disorder or deranged coagulation parameters Psychiatric illnesses Allergy to any of the drugs used in the study

Ages Eligible for Study
-----------------
Minimum Age: 21 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: spinal anesthesia only<br>Patients will receive spinal anesthesia only | Procedure: Spinal anesthesia only<br>* Patients will receive spinal anesthesia with 2-3 ml 0.5% (10-15 mg) hyperbaric bupivacaine plus 25 ug fentanyl at the L3/4 interspaces.<br>|
| Experimental: spinal anesthesia and ultrasound-guided Genicular nerves block<br>Patients will receive spinal anesthesia and ultrasound-guided Genicular nerves block | Biological: Spinal anesthesia and ultrasound-guided Genicular nerves block<br>* Patients will receive16 ml bupivacaine 0025% will be administered, and4 ml of this solution will be placed at each of the 4 target nerves.<br>|
| Experimental: Spinal anesthesia and US guided Adductor canal nerve block plus infiltration of the interspace<br>Patients will receive spinal anesthesia and ultrasound-guided Adductor canal nerve block plus infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (PACK) block. | Biological: Ultrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK)<br>* Adductor Canal block (ACB) technique will be performed using 16 ml bupivacaine 0025% As regarding the Popliteal artery and the capsule of posterior knee block ('PACK), it will be performed Using 16 ml bupivacaine 0.25%<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative 24-hour rescue analgesic consumption | Total postoperative 24-hour rescue analgesic consumption will be recorded | 24 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-operative pain | Post-operative pain will be assessed by the Numeric Rating Scale (NRS) rest and mobilization. | 24 hours Postoperative | 
| Time taken till 1st rescue analgesic request | The time till administration of first rescue analgesia will be recorded | 24 hours Postoperative |