Arthroscopy, Genicular Nerves Block
Conditions
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.
Interventions
PROCEDURESpinal anesthesia only
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.
BIOLOGICALSpinal anesthesia and ultrasound-guided Genicular nerves block
Patients will receive16 ml bupivacaine 0025% will be administered, and4 ml of this solution will be placed at each of the 4 target nerves.
BIOLOGICALUltrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK)
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%
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative 24-hour rescue analgesic consumption | 24 hours postoperative | Total postoperative 24-hour rescue analgesic consumption will be recorded |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative pain | 24 hours Postoperative | Post-operative pain will be assessed by the Numeric Rating Scale (NRS) rest and mobilization. |
| Time taken till 1st rescue analgesic request | 24 hours Postoperative | The time till administration of first rescue analgesia will be recorded |
Outcome results
None listed