Adductor Canal Block With IPACK Versus 4-in-1 Block for Postoperative Analgesia in Knee Surgery

Effect of Adductor Canal Block With Infiltration of the Posterior Capsule of the Knee Versus 4-in-1 Block Technique for Postoperative Analgesia in Patients Undergoing Knee Surgeries

Status

Completed

Phases

Unknown

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT07700797

Enrollment

Registered

2026-07-14

Start date

2026-06-22

Completion date

2026-06-22

Last updated

2026-07-17

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Anterior Cruciate Ligament (ACL) Tear, Knee Surgeries, Posterior Cruciate Ligament Tear, Total Ankle Arthroplasty

Keywords

Adductor canal block, IPACK, 4 in 1 block, Knee surgeries, Postoperative analgesia, Regional anesthesia, Ultrasound guided nerve block

Brief summary

This randomized interventional study compares the analgesic efficacy of Adductor Canal Block combined with Infiltration of the Posterior Capsule of the Knee (IPCAK) versus the 4-in-1 block technique in patients undergoing knee surgery. Twenty-four patients were randomly allocated into two equal groups. The primary objective is to compare postoperative pain scores and analgesic requirements. Secondary outcomes include time to first rescue analgesia, total analgesic consumption, motor function preservation, and block-related complications.

Detailed description

Effective postoperative pain control following knee surgery is essential for early mobilization, rehabilitation, and patient satisfaction. Several regional anesthesia techniques have been developed to provide analgesia while preserving quadriceps muscle strength. Adductor Canal Block combined with Infiltration of the Posterior Capsule of the Knee (IPCAK) has been proposed as a motor-sparing technique that provides effective anterior and posterior knee analgesia. The 4-in-1 block is another ultrasound-guided regional anesthesia technique designed to provide comprehensive analgesia for knee surgery. This prospective randomized interventional study enrolled 24 patients undergoing knee surgery. Participants were randomly assigned to receive either Adductor Canal Block with IPCAK or the 4-in-1 block. Postoperative pain scores, time to first rescue analgesia, total analgesic consumption, motor function, patient satisfaction, and complications were evaluated and compared between the two groups

Interventions

PROCEDUREAdductor canal block with IPACK

Ultrasound-guided Adductor Canal Block combined with IPCAK block

PROCEDURE4 in 1 block

Ultrasound-guided 4-in-1 block technique.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

21 Years to 64 Years

Healthy volunteers

Yes

Inclusion criteria

* 1\. Patients or caregivers acceptance. 2. Age : 21 - 64 years 3. Sex : both ( males \& females). 4. Physical status: ASA І \& II. 5. BMI 18.5-30 kg/m2. 6. Type of operations : elective surgery. 7. Type of anesthesia: unilateral intrathecal anesthesia. 8. Patients undergoing elective knee surgery under unilateral spinal anesthesia 9. Duration of surgery within 2 hr.

Exclusion criteria

* Known history of allergy to study drug Coagulopathies or taking drugs affecting coagulation.. Contraindications for peripheral nerve block (PNB) and spinal anesthesia (SA) (coagulation defects, infection at the puncture site), bone degenerative disease and posttraumatic condition of the spine, dementia and severe visual or auditory disorder. Current severe psychiatric disease, alcoholism or drug dependence. Subjects with history previous knee surgery, osteoarthritis, malformation or tumors (including Baker's cyst), which could alter the normal anatomy of the popliteal fossa

Design outcomes

Primary

Measure	Time frame	Description
Postoperative pain intensity measured by Visual Analog Scale (VAS)	24 hours after surgery	Postoperative pain will be assessed using the Visual Analog Scale (VAS) at rest and during movement at predetermined postoperative time points

Secondary

Measure	Time frame	Description
Total opioid consumption	First 24 hours after surgery	Total rescue opioid analgesic consumption during the first 24 postoperative hours
Time to first rescue analgesia	Within 24 hours after surgery	Time from completion of surgery to the first request for rescue analgesia
Patient satisfaction with postoperative analgesia	24 hours after surgery	Patient satisfaction score regarding postoperative pain management

Countries

Egypt

Contacts

STUDY_CHAIRAbdalla Mohamed Goda, MD

Faculty of Medicine, Zagazig University

STUDY_DIRECTORYasser Mohamed Naser, MD