Knee Arthropathy, Postoperative Pain
Conditions
Keywords
knee arthoplasty, nerve block, analgesia
Brief summary
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
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
Interventions
PROCEDUREadductor canal block
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%.
PROCEDUREIPACK block
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
Sponsors
Institut Kassab d'Orthopédie
University Tunis El Manar
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption | Day 2 | total Morphine consumption |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain score at rest | Day 2 | numerical rating scale \[0=no pain ; 10=worste pain\] |
| Pain score during mouvment | Day 2 [0=no pain ; 10=worste pain] | numerical rating scale |
| Ambulation distance | Day 2 | number of steps walked by the patient |
| Chronic pain | Month 6 | DN4 score \[0=minimum to 10= worste score\] |
| functional status | Month 6 | KOOS PS score \[0=minimum to 28= worste score\] |
Countries
Tunisia
Outcome results
None listed