Postoperative Pain
Conditions
Keywords
BiFeS Block, iPACK Block, Postoperative pain scores, Time to mobilization, Total opioid consumption
Brief summary
This study aims to compare the effects of two regional analgesia techniques applied in patients undergoing unilateral total knee arthroplasty-Infiltration between the Popliteal Artery and the Capsule of the Knee (iPACK) block and the Biceps Femoris Short Head Plane (BiFeS) block-on ease of application, postoperative pain scores, time to mobilization, total postoperative opioid consumption, need for first rescue analgesia, and the incidence of nausea-vomiting and pruritus.All patients will be followed postoperatively according to a standard pain management protocol, and pain assessments will be performed at predetermined time intervals using the VAS (Visual Analog Scale).
Detailed description
Total knee arthroplasty is one of the most commonly performed orthopedic procedures. Patients experience significant pain in the postoperative period. This pain delays recovery, prolongs the time to mobilization, and increases the length of hospital stay. Currently, multimodal analgesia techniques are used for postoperative pain management. These methods include systemic opioids, epidural analgesia, lumbar plexus block, femoral block, adductor canal block, iPACK block, and the newly defined and proven effective BiFeS block. In recent years, the adductor canal block has been frequently preferred because it is applied more distally and does not cause motor blockade. It primarily provides analgesia to the anteromedial aspect of the knee. The iPACK block and the BiFeS block can be used as complementary techniques to the adductor canal block, as they also affect the nerves responsible for the posterolateral innervation of the knee. Since they do not produce motor blockade, they are thought to contribute to early postoperative mobilization. During the iPACK block, local anesthetic is infiltrated between the posterior capsule of the knee and the popliteal artery. It has also been shown that a superior lateral genicular nerve block should be added to this block. The BiFeS block is performed with the patient in the supine position by infiltrating local anesthetic between the short head of the biceps femoris muscle and the lateral femoral condyle at a more proximal level. Due to its distance from the surgical site, the risk of infection is lower. In this study, the investigators aimed to compare the ease of application and the roles of these blocks-routinely performed at our center as part of multimodal analgesia-in providing effective postoperative analgesia.
Interventions
PROCEDUREIPACK block
Unilateral iPACK block with 25 mL of mixture 1:1 (0.5 % bupivacaine: 0.9% NaCl)
PROCEDUREBiFeS Block
Unilateral BiFeS block with 25 mL of mixture 1:1 (0.5 % bupivacaine: 0.9% NaCl)
Sponsors
Soma State Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Intervention model description
This is a prospective, randomized, double-blind, non-inferiority clinical trial.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for unilateral total knee arthroplasty * Patients aged between 18 and 75 years * Patients with ASA physical status I-III
Exclusion criteria
* Patients with neuropsychiatric disorders * Patients with obesity (BMI \> 30) * Presence of local infection at the site where the block will be performed * Patients with coagulation disorders * Patients with uncontrolled diabetes mellitus * Opioid dependence * History of allergy to local anesthetic agents * Refusal to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| VAS Scores | Postoperative 8th-hour | A score of 0 indicates no pain, while a score of 10 represents the worst pain imaginable. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| VAS Scores | Postoperative 2,4,6,12,24th-hour rest and movement | A score of 0 indicates no pain, while a score of 10 represents the worst pain imaginable. |
| Total opioid consumption | 24 hours after surgery | Patients with a VAS score \> 4 will receive 1 mg/kg intravenous tramadol. |
| Time to first mobilization | 24 hours after surgery | The postoperative hour at which the patients are comfortably mobilized is recorded. |
Countries
Turkey (Türkiye)
Contacts
CONTACTMeltem Savas Ozdemir, MD
Outcome results
None listed