Pain Management After Adductor Canal Block for Total Knee Arthroplasty

Study Overview
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Brief Summary
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This randomized, double-blinded, placebo-controlled trial sought to evaluate the efficacy of the iPACK block with Adductor Canal Block on postoperative pain, functional recovery and NLR and PLR levels.

Detailed Description
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The Interspace between the popliteal artery and capsule of the posterior knee, or iPACK block, together with the Adductor Canal block (ACB), has been described and shows promise in providing analgesia to the knee joint. However, the effect of these two blocks on postoperative pain levels, functional recovery, and stress response is uncertain. This study compares a preoperative iPACK and ACB block to Sham blocks before total knee arthroplasty under spinal anesthesia.

Official Title
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Pain Management and Functional Recovery After Adductor Canal Block Combined With iPACK Block for Total Knee Arthroplasty. A Prospective, Randomized, Double-blinded Clinical Trial.

Conditions
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Knee Osteoarthritis, Knee Arthritis, Knee Arthropathy, Knee Pain Chronic

Intervention / Treatment
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* Drug: Ropivacaine 0.2% Injectable Solution
* Drug: 0.9%sodium chloride


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients > 18 years old undergoing unilateral total knee arthroplasty Exclusion Criteria: refusal to participate < 18 yo Chronic opioid use localized infection

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

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
Interventional Model Description: randomized, double-blind, placebo-controlled
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: iPACK block+ABC block<br>Patients received a preoperative ultrasound-guided iPACK block with 20 mL of 0.25% ropivacaine and an Adductor Canal block with 20mL 0.25% ropivacaine. | Drug: Ropivacaine 0.2% Injectable Solution<br>* 20 mL 0.5% ropivacaine was injected into the PENG block 20 mL 0.5% ropivacaine was injected into the Adductor Canal block<br>* Other names: Ropimol;|
| Active Comparator: Sham blocks<br>Patients received a preoperative ultrasound-guided iPACK block with 20 mL of 0.9% normal saline and an Adductor Canal block with 20mL 0.9% normal saline. | Drug: 0.9%sodium chloride<br>* 20 mL 0.9% sodium chloride was injected into the PENG block 20 mL 0.5% sodium chloride was injected into the Adductor Canal block<br>* Other names: normal saline;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative Numeric Pain Rating Scale | Numeric Pain Rating Scale. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable) | 24 hours after surgery | 
| postoperative Numeric Pain Rating Scale et rest | Numeric Pain Rating Scale. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable) | 48 hours after surgery | 
| postoperative Numeric Pain Rating Scale et rest | Numeric Pain Rating Scale. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable) | 72 hours after surgery | 
| postoperative Numeric Pain Rating Scale et rest | Numeric Pain Rating Scale. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable) | 96 hours after surgery | 
| postoperative Numeric Pain Rating Scale during active flexion | Numeric Pain Rating Scale. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable) | 48 hours after surgery | 
| postoperative Numeric Pain Rating Scale during active flexion | Numeric Pain Rating Scale. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable) | 72 hours after surgery | 
| postoperative Numeric Pain Rating Scale during active flexion | Numeric Pain Rating Scale. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable) | 96 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative opioid consumption | milligrams of intravenous morphine equivalents | 96 hours after surgery | 
| Neutrophil-to-lymphocyte ratio | Neutrophil-to-lymphocyte ratio | 12 hours after surgery | 
| Neutrophil-to-lymphocyte ratio | Neutrophil-to-lymphocyte ratio | 24 hours after surgery | 
| Platelet-to-lymphocyte ratio | Platelet-to-lymphocyte ratio | 12 hours after surgery | 
| Platelet-to-lymphocyte ratio | Platelet-to-lymphocyte ratio | 24 hours after surgery | 
| Time to first opioid administration | Hours to first administration of an intravenous opioid drug | 96 hours postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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iPACK, Adductor Canal Block, pain management, multimodal analgesia, peripheral nerve block, knee arthroplasty