Arthropathy of Knee, Early Ambulation, Pain Management, Pain, Postoperative
Conditions
Brief summary
Total knee arthroplasty (TKA) is frequently associated with significant postoperative pain, which may delay early mobilization and negatively affect functional recovery. Peripheral nerve blocks are widely used as part of multimodal analgesia strategies to improve postoperative pain control while minimizing opioid consumption and preserving motor function. Different peripheral nerve block techniques may result in varying analgesic efficacy and mobilization outcomes. The aim of this prospective observational study is to compare the effects of commonly used peripheral nerve block techniques on postoperative pain control and early mobilization in patients undergoing total knee arthroplasty under spinal anesthesia. Patients receiving fascia iliaca plane block are compared with those receiving a combination of adductor canal block and interspace between the popliteal artery and capsule of the knee (IPACK) block. The primary outcome is postoperative opioid consumption within the first 24 hours after surgery. Secondary outcomes include postoperative pain scores assessed at predefined time intervals, early mobilization parameters, and opioid-related adverse effects. The findings of this study are intended to contribute to optimizing analgesic strategies and improving early functional recovery following total knee arthroplasty.
Detailed description
Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure associated with moderate to severe postoperative pain that may impair early mobilization and delay rehabilitation. Effective postoperative analgesia is essential to facilitate early functional recovery, reduce opioid consumption, and minimize postoperative complications. Multimodal analgesia strategies incorporating peripheral nerve blocks have become increasingly important in postoperative pain management following TKA. Peripheral nerve block techniques aim to provide effective analgesia while preserving motor function to support early ambulation. Traditional proximal blocks may provide adequate pain relief but can be associated with motor weakness that limits mobilization. More distal techniques, such as the adductor canal block, are increasingly preferred due to their motor-sparing characteristics. The interspace between the popliteal artery and capsule of the knee (IPACK) block has been introduced to improve posterior knee analgesia without affecting motor function. The fascia iliaca plane block represents another commonly used regional anesthesia technique; however, comparative clinical data regarding analgesic efficacy and mobilization outcomes between these approaches remain limited. This prospective observational study is conducted in patients undergoing unilateral total knee arthroplasty under spinal anesthesia. Participants receive either fascia iliaca plane block or a combination of adductor canal block and IPACK block as part of routine clinical practice. The study evaluates postoperative outcomes during the first 24 hours following surgery. The primary objective is to compare total opioid consumption within the first 24 postoperative hours between the two peripheral nerve block techniques. Secondary objectives include assessment of postoperative pain intensity using the Numeric Rating Scale (NRS) at predefined time points, evaluation of early mobilization parameters, and comparison of opioid-related adverse effects. Pain assessments are performed at 0, 2, 6, 12, and 24 hours postoperatively. Early mobilization is evaluated using standardized functional assessments, including walking ability and motor function tests of quadriceps and ankle dorsiflexor muscles. All patients receive standardized spinal anesthesia and postoperative patient-controlled analgesia to ensure comparable perioperative management. The results of this study are expected to provide clinical evidence regarding the comparative effectiveness of commonly used peripheral nerve block techniques and to support optimization of postoperative analgesia protocols aimed at improving recovery after total knee arthroplasty.
Interventions
PROCEDUREFascia Iliaca Plane Block
Ultrasound-guided fascia iliaca plane block is performed under sterile conditions prior to surgery as part of perioperative analgesia. Using an in-plane technique with a high-frequency linear ultrasound probe, the needle is advanced beneath the fascia iliaca, and 40 mL of 0.25% bupivacaine is injected incrementally after negative aspiration to achieve spread within the fascia iliaca compartment.
PROCEDUREAdductor Canal Block + IPACK Block
An ultrasound-guided adductor canal block followed by an interspace between the popliteal artery and capsule of the knee (IPACK) block is performed prior to surgery as part of perioperative analgesia. The adductor canal block is administered using 20 mL of 0.25% bupivacaine injected adjacent to the femoral artery beneath the sartorius muscle. Subsequently, the IPACK block is performed with 20 mL of 0.25% bupivacaine injected into the tissue plane between the popliteal artery and the posterior capsule of the knee under ultrasound guidance.
Sponsors
Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients aged 18-80 years * Scheduled for elective unilateral total knee arthroplasty * Surgery performed under spinal anesthesia * American Society of Anesthesiologists (ASA) physical status I-III * Ability to understand the study procedures and provide informed consent
Exclusion criteria
* Refusal to participate * Contraindications to spinal anesthesia or peripheral nerve block * Known allergy to local anesthetics * Chronic opioid use or opioid dependence * Preexisting neurological or neuromuscular disorders affecting lower extremities * Cognitive impairment preventing pain assessment * Infection at the injection site * Coagulopathy or ongoing anticoagulant therapy contraindicating regional anesthesia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Postoperative Opioid Consumption | Within the first 24 hours after surgery | Total opioid consumption administered via patient-controlled analgesia (PCA) during the first 24 hours following total knee arthroplasty. Opioid use is recorded as the cumulative dose of morphine (mg) delivered by the PCA device. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity (NRS Score) | 0, 2, 6, 12, and 24 hours after surgery | Postoperative pain intensity assessed using the Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst imaginable pain. Pain scores are recorded at predefined postoperative time points under resting conditions. |
| Early Mobilization Performance | 24 hours after surgery | Early postoperative mobilization assessed using standardized functional evaluations, including walking ability, quadriceps muscle strength, and ankle dorsiflexor motor function scores recorded at postoperative assessment. |
Countries
Turkey (Türkiye)
Outcome results
None listed