Postoperative Pain
Conditions
Keywords
genicular ,IPACK, total knee
Brief summary
Comparison of the analgesic and physical recovery effect of genicular nerve block (GNB) alone and (GNB + infiltration between popliteal artery and posterior capsule of the knee (IPACK) in patients undergoing total knee replacement
Detailed description
Comparison of preemptive analgesia of (GNB) with (GNB+ IPACK) on postoperative pain control and recovery of knee physical activity in patient undergoing total knee replacement.
Interventions
PROCEDUREGNB plus standard analgesia
When patients are in supine position with a pillow under the popliteal fossa, we will target points next to superior medial, superior lateral, and inferior medial genicular arteries to block the superior medial, superior lateral, and inferior medial branches of genicular nerve. For identification, we will use color Doppler near the periosteal areas (the junctions of the epicondyle with the shafts of the femur and tibia, accordingly). using a 12 MHz linear transducer (XarioTM SSA-660A, Toshiba Medical Systems Corporation, Otawara, Japan) positioned parallel to the shaft of the long bones in the legs, the needle will be inserted ( in plane technique in the long-axis view) and a 2.5 mL of bupivacaine (5%) will be injected at each target points.standard analgesia will be given post-operativelly (paracetamol 1 gm/ three times a daily and meloxicam (15 mg)once a day)
PROCEDUREGNB plus IPACK block plus standard analgesia
IPACK block will be done when the patients in supine position with the knee flexed in 45 degree. using a low frequency transducer at a depth of 3.5-4 cm positioned transversely, 2-3 cm above the patella and over the medial aspect of the knee, we will identify the distal part of the shaft of the femur and the popliteal artery with sliding the transducer proximally and distally (If the two femoral condyles appear first, proximal sliding of the probe, so the humps of the femoral condyles will disappeared and the flat metaphysis will appeared). With advancement of the needle in plane toward the space between the popliteal artery and the femur, 15 ml of bupivacaine 0.5% will be injected. The genicular nerve block will be done as in group G and standard analgesia will be given post-operative as in group G
DRUGstandard analgesia (paracetamol and meloxicam)
(paracetamol 1 gm 3 times a daily and meloxicam (15 mg) once aday.
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Adult patients aged between 21 to 60 years * undergoing primary unilateral elective total knee arthroplasty under spinal anesthesia * Having informed consents * patients with physical status ASA I & II * both genders * body mass index less than 40 kg/m2.
Exclusion criteria
* patients with Peripheral vascular disease * patients with history of allergy to local anesthesia or opioid analgesia, * those on anti-platelet, anticoagulant or B blocker drugs * Patients with acute decompensated heart failure * Patients with hypertension * Patients with heart block * Patients with coronary disease * Patients with bronchial asthma * Patients with bleeding disorders * Patients with compromised renal or hepatic function * pregnant female.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 24 hours visual analogue score | at 24 hours postoperative | pain intensity at rest and with motion using visual analogue scale from horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10. |
| 2 hours visual analogue scale | at 2 hour postoperative. | pain intensity at rest and with motion using visual analogue scale from horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10. |
| 4 hours visual analogue score | at 4 hours postoperative | pain intensity at rest and with motion using visual analogue scale from horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10. |
| 6 hours visual analogue score | at 6 hours postoperative | pain intensity at rest and with motion using visual analogue scale from horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10. |
| 8 hours visual analogue score | at 8 hours postopertaive | pain intensity at rest and with motion using visual analogue scale from horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10. |
| 12 hours visual analogue score | at 12 hours postoperative | pain intensity at rest and with motion using visual analogue scale from horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10. |
| 18 hours visual analogue score | at 18 hours postoperative | pain intensity at rest and with motion using visual analogue scale from horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| • Time of performance of block | from putting of U.S probe till the end of block procedure | defined as time from putting of U.S probe till the end of block procedure. |
| • Total morphine consumption | at 24 hours post-operatively | Total morphine consumption |
| •incidence of Anticipated side effect | at 24,48 hours postoperative | nausea, vomiting, itching, hemorrhage, bradycardia and hypotension. |
| degree of maximum active flexion and extension of the knee | at 24 hours post operative | the angle of maximum active flexion and extension of the knee |
| walk test | at 24 hours post operative | walking distance in meters that patients can wake during 2 min |
| holding quadriceps muscle | at 24 hours post operative | number of patients capable to hold quadriceps muscle more than 5 seconds. |
| time up and go (TUG) | at 24 hours post operative | the time required for the patient to stand up from a standard-height armchair, walk 3 meters, turn, walk back to the chair, and sit down |
Countries
Egypt
Contacts
Primary ContactHeba M Fathi, MD
Outcome results
None listed