Osteo Arthritis of the Knee
Conditions
Keywords
Total knee arthroplasty, popliteal plexus block, femoral triangle block, iPACK block (infiltration of the interspace between the popliteal artery and the posterior knee capsule)
Brief summary
This study aims to investigate the effect of femoral triangle block combined with popliteal plexus block and distal IPACK block on postoperative pain after total knee arthroplasty (TKA)
Detailed description
Popliteal Plexus Block (PPB) is a new nerve block technique that has been shown to anaesthetise nerves involved in the innervation of the posterior part of the knee joint. The IPACK (interspace between the popliteal artery and capsule of the posterior knee) block is a regional anesthesia technique in which a local anesthetic is infiltrated under ultrasound guidance between the popliteal artery and the capsule of the posterior knee. This technique blocks the branches of the obturator nerve, the common peroneal nerve, and the tibial nerve in the popliteal region. In the context of knee arthroplasty, the application of the IPACK block has been associated with lower scores for ambulatory pain, lower scores for resting pain, and reduced morphine consumption. Although both techniques of blockade seem to be efficient in the context of analgesia for the posterior part of the knee after TKA. No study compares these two blocks as part of multimodal analgesia to provide pain relief after TKA. This study aimed to evaluate the analgesic effect of PPB or distal IPACK, in addition to femoral triangle block, as a component of a multimodal analgesic regimen after TKA.
Interventions
DEVICEfemoral triangle block and popliteal plexus block
Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for PPB
DEVICEFemoral triangle block and distal iPACK
Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for distal iPACK
Sponsors
Karaman Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing total knee arthroplasty under spinal anesthesia * American Society of Anesthesiologists (ASA) status I-III * Patients who give informed consent
Exclusion criteria
* Patients unable to cooperate * Kidney disease with GFR \< 50 ml/min * Daily opioid consumption \> 1 month * Allergy to local anesthetics * Neurological problems of the lower extremity * Contraindications to peripheral nerve blocks
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Opioid consumption | 24 hours | Total opioid consumption in each group, A, B until 24 hours postoperative. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| NRS scores | 48 hours | Numerical Rating Scale (NRS) scores (Range 0-10, 0=no pain, 10=the worse pain ever) |
| Range of knee motion | 48 hours | Degrees of flexion |
| Patient mobilization | 48 hours | Patient reporting time of first standing to the side of the bed and time up and go test 2 days |
| Post-block Maximum Voluntary Isometric Contraction (MVIC) by knee extension, calculated as a percentage of the Pre-block baseline value | A 60-minute interval is between pre-block and post-block MVIC assessments | Both MVIC test are assessed preoperative, using a handheld dynamometer |
| Post-block MVIC by ankle plantarflexion, calculated as a percentage of the Pre-block baseline value | A 60-minute interval is between pre-block and post-block MVIC assessments | Both MVIC tests are assessed preoperative, using a handheld dynamometer |
| Post-block MVIC by ankle dorsiflexion, calculated as a percentage of the Pre-block baseline value | A 60 minutes interval is between pre-block and post-block MVIC assessments | Both MVIC tests are assessed preoperative, using a handheld dynamometer |
| Muscle strength of knee extension, graded by Manual Muscle Test (MMT) | Assessed pre-block, post-block (60 minutes after pre-block), and postoperative 5 hours | Grade 3: Able to extend the knee in active Range of Motion (ROM) against gravity, Grade 2: Patient is lying on the side, with knee resting on the bed, able to extend the knee in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the quadriceps muscle is palpable or observable but the knee does not extend, Grade 0: No muscle contraction of the quadriceps muscle is palpable or observable |
| Muscle strength of ankle plantarflexion, graded by MMT | Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours | Grade 3: Able to plantarflex in active ROM, Grade 2: Patient is lying on the side, with ankle resting on the bed, able to plantarflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the gastrocnemius muscle is palpable or observable but the ankle does not plantarflex, Grade 0: No muscle contraction of the gastrocnemius muscle is palpable or observable |
| Muscle strength of ankle dorsiflexion, graded by MMT | Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours | Grade 3: Able to dorsiflex in active ROM Grade 2: Patient is lying on the side, with ankle resting on the bed, able to dorsiflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the tibialis anterior muscle is palpable or observable but the ankle does not dorsiflex, Grade 0: No muscle contraction of the tibialis anterior muscle is palpable or observable |
| Incidence of rebound pain | Postoperative 24 hours | Rebound pain is described as severe pain (NRS ≥ 7) |
| Quality of Recovery 15 Score | Postoperative Day 1 | Quality of Recovery (QoR)-15 survey.Minimum value: 0, Maximum value: 150, higher scores mean better. |
Countries
Turkey (Türkiye)
Contacts
CONTACTTayfun Et
Outcome results
None listed