Anesthesia, Knee Osteoarthritis, Pain, Acute
Conditions
Keywords
Ipack, Block, Total knee replacement
Brief summary
Total knee replacement surgery is associated with significant pain in the immediate postoperative period, especially in movement. In turn, this is associated with more subsequent chronic pain. There are multiple options and the tendency is to perform increasingly distal nerve blocks to minimize limb weakness and thus allow early rehabilitation. In 2012, in an oral communication, Sanjay Sinha described a new nerve block called iPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee). There are few studies on the efficacy of such a blockade so far, but none comparing the groups saphene + sciatic blocks vs. saphene + iPACK blocks. Therefore, this study aims to provide more information on the effectiveness this nerve blocks, in total knee replacement, in terms of analgesia and motor function.
Interventions
DRUGIPACK block with Bupivacaine 0.25% with adrenaline
The iPACK in performed in the popliteal fossa about 1 finger breath above the patella, ecoguided. That aims to anesthetize the articular branches to the posterior aspect of the knee in the popliteal region.
Sponsors
Germans Trias i Pujol Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with osteoarthritis scheduled for total primary knee arthroplasty with same surgeons * Locoregional anesthesia * Age equal to or greater than 18 years * Consent to participate in the study
Exclusion criteria
* Age under 18 years old * General anesthesia * Allergy to local anesthetics * Severe kidney failure (Cr ≥ 2mg / dL) * Chronic opioid use (over 3 months) * Chronic pregabalin / gabapentin use (more than 3 months) * Psychiatric illness that may interfere with the evaluation or follow-up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Motor block | 6 hours after surgery | Measured on a scale of 3, where 0 = no motor block, 1 = partial motor block and 2 = complete motor block. It will be performed on plantar flexion (distribution of the tibial nerve) and dorsiflexion (peroneal distribution)). |
| Pain at movement | 6 hours after surgery | Measured by the numerical visual scale at 48 hours after intradural anesthesia, minimum of 0 and maximum of 10, where means no pain and 10 means the worst pain in the life of the patient. |
| Pain at rest | 6 hours after surgery | Measured by the numerical visual scale at 6 hours after intradural anesthesia, minimum of 0 and maximum of 10, where means no pain and 10 means the worst pain in the life of the patient. |
| Pain with movement | 24 hours after surgery | Measured by the numerical visual scale at 48 hours after intradural anesthesia, minimum of 0 and maximum of 10, where means no pain and 10 means the worst pain in the life of the patient. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opioids dose | 6 hours after surgery | Measured in milligrams of intravenous morphine hydrochloride daily. |
| Discharge days | Days | Time to discharge measured in days |
| Patient satisfaction | 24 hours after surgery | Patient satisfaction on a scale of 0 to 10, where 0 is minimum satisfaction and 10 is maximum satisfaction. |
| Ambulation time | Up to 24 hours | Time to ambulation (measured in hours) from discharge from URPA |
Countries
Spain
Contacts
Primary ContactMadalina Dinu, Mrs
Outcome results
None listed