Total Knee Arthroplasty, Postoperative Pain
Conditions
Keywords
Adductor Canal Block, iPACK Block, Total Knee Arthroplasty, Postoperative Analgesia, Early Mobilization, Regional Anesthesia
Brief summary
This study compares the effects of adding an infiltration between the popliteal artery and capsule of the knee (iPACK) block to a continuous adductor canal block (CACB) versus continuous adductor canal block alone on postoperative analgesia, opioid consumption, early mobilization, and length of hospital stay in patients undergoing total knee arthroplasty. This is a prospective, randomized, double-blind study with 54 patients allocated 1:1 into two groups.
Detailed description
Severe postoperative pain occurs in up to 58% of patients after total knee arthroplasty. Peripheral nerve blocks are an effective component of multimodal analgesia, and the continuous adductor canal block (CACB) has become a preferred technique because it provides sensory blockade while sparing motor function of the quadriceps, allowing earlier ambulation compared to femoral nerve block. However, CACB does not address posterior knee pain, which can be targeted by the iPACK (infiltration between the popliteal artery and capsule of the knee) block, a technique that blocks terminal sensory branches of the tibial and peroneal nerves without motor blockade. In this study, patients scheduled for total knee arthroplasty will be randomized 1:1 (using randomizer.org) to receive either CACB alone (Group 2) or CACB combined with a single-injection iPACK block (Group 1). CACB will be maintained via a perineural catheter connected to a patient-controlled analgesia (PCA) pump delivering 0.1% bupivacaine. Rescue analgesia will be provided with intravenous tramadol (50 mg, max 300 mg/day) when the numeric rating scale (NRS) pain score exceeds 4. Pain scores (NRS 0-10), total analgesic and opioid consumption, hemodynamic parameters, time to first mobilization (assessed via the Timed Up and Go test), patient satisfaction, and length of hospital stay will be recorded at baseline and at 1, 3, 6, 12, and 24 hours postoperatively by an anesthesiologist blinded to group allocation, different from the anesthesiologist who performed the block.
Interventions
PROCEDUREIPACK block
Single injection of 0.25% bupivacaine 20 mL between the popliteal artery and posterior knee capsule, performed under ultrasound guidance
Perineural catheter placement in the adductor canal with PCA-delivered 0.1% bupivacaine (5-7 mL basal rate, 5 mL bolus, 30-min lockout) for 24 hours postoperatively
Sponsors
Başakşehir Çam & Sakura City Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients of either sex * Aged 18 to 75 years * American Society of Anesthesiologists (ASA) physical status I, II, or III * Voluntary participation * Fully oriented and able to cooperate with postoperative assessments
Exclusion criteria
* ASA physical status IV or V * Patients who decline to participate * Pediatric patients * Active infection at the block site * Chronic pain or regular analgesic use * Coagulation disorders * Inability to cooperate with postoperative pain assessment * Known allergy to local anesthetics * Neuropathy or myopathy in the operated extremity * Revision arthroplasty cases
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Score (Numeric Rating Scale) | Baseline and postoperative hours 1, 3, 6, 12, and 24 | Pain intensity assessed using the Numeric Rating Scale (NRS, 0-10; 0 = no pain, 10 = worst pain imaginable) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total Opioid Consumption | Postoperative 24 hours | Total rescue analgesic (tramadol) consumption via intravenous (IV) administration |
| Total Local Anesthetic Consumption | Postoperative 24 hours | Total bupivacaine consumed via patient-controlled analgesia (PCA) pump |
| Time to First Mobilization | Postoperative 24 hours | Time to first unassisted ambulation/movement, assessed via the Timed Up and Go (TUG) test |
| Length of Hospital Stay | From surgery to discharge (up to approximately 1 week) | Number of days from surgery to discharge |
| Patient Satisfaction Score | Postoperative 24 hours | Satisfaction rated on a 4-point scale (1 = not satisfied, 2 = Slightly satisfied, 3 = Satisfied, 4 = very satisfied) |
| Systolic Blood Pressure | Baseline and postoperative hours 1, 3, 6, 12, and 24 | Systolic blood pressure measured in mmHg |
| Diastolic Blood Pressure | Baseline and postoperative hours 1, 3, 6, 12, and 24 | Diastolic blood pressure measured in mmHg |
| Mean Arterial Blood Pressure | Baseline and postoperative hours 1, 3, 6, 12, and 24 | Mean arterial blood pressure (MAP) measured in mmHg |
| Heart Rate | Baseline and postoperative hours 1, 3, 6, 12, and 24 | Heart rate measured in beats per minute |
| Peripheral Oxygen Saturation | Baseline and postoperative hours 1, 3, 6, 12, and 24 | Peripheral oxygen saturation (SpO2) measured as a percentage |
| Block-Related Complications | Throughout study participation (up to 24 hours postoperatively) | Incidence of complications associated with the regional block techniques (e.g., nerve injury, infection) |
Countries
Turkey (Türkiye)
Contacts
CONTACTMuzaffer GENCER, MD
CONTACTFurkan TONTU, MD
PRINCIPAL_INVESTIGATORFurkan TONTU, MD
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ
STUDY_DIRECTORMuzaffer GENCER, MD
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ
STUDY_DIRECTORMurat Y Mersin, MD
BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİt
Outcome results
None listed