LIA vs. LIA + ACB-iPACK Block for Total Knee Arthroplasty

NCT ID: NCT04808947

Last Updated: 2025-07-16

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2027-01-31
• Study Completion Date: 2028-12-31

Brief Summary

LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. The combination of ACB-iPACK blocks has also been proposed as an effective analgesic modality for total knee arthroplasty. However, whether combining these two modalities yields any important incremental analgesic benefit remains unclear. The investigators hypothesized that the addition of ACB and iPACK blocks to LIA will yield clinically important analgesic benefits compared to LIA alone in patients having total knee arthroplasty.

Detailed Description

LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. Performed by surgeons, LIA provides effective postoperative pain relief and reduces opioid requirements. Similar analgesic benefits have also been attributed to adductor canal and iPACK blocks, which partially block sensory innervation to the knee and its posterior capsule. Performed by anesthesiologist preoperatively, these blocks have also been incorporated into the care standard in numerous centers. However, it is not clear whether adding the adductor canal and iPACK blocks yields any incremental analgesic benefits. The investigators aimed to evaluate the benefits of adding adductor canal and iPACK blocks to LIA in patients having total knee arthroplasty.

Conditions

Nerve Block; Neuromuscular Blockade

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Local infiltration analgesia

Patients in this group will receive LIA intraoperatively, as per institutional standard. The injected solution will be comprised of 100cc Ropiv 2%, + Ketorolac 30 mg + Epinephrine 25 ug.

Group Type: EXPERIMENTAL

Local infiltration analgesia

Intervention Type: PROCEDURE

Procedure: Local infiltration analgesia performed by surgeons.

Local infiltration analgesia + ACB-iPACK block

Patients in this group will receive LIA intraoperatively, as per institutional standard. The injected solution will be comprised of 100cc Ropiv 2%, + Ketorolac 30 mg + Epinephrine 25 ug.

Patients in this group will also receive preoperative nerve blocks under ultrasound guidance. These will include:

1. Adductor canal block with 0.5% Ropivacaine w/epi 20 mL

2. iPack block with 0.25% Ropivacaine w/epi 10 mL

Group Type: ACTIVE_COMPARATOR

Local infiltration analgesia

Intervention Type: PROCEDURE

Procedure: Local infiltration analgesia performed by surgeons.

Ultrasound-guided adductor canal block

Intervention Type: PROCEDURE

Procedure: Ultrasound-guided adductor canal and iPACK blocks performed by anesthesiologists preoperatively.

Interventions

Local infiltration analgesia

Procedure: Local infiltration analgesia performed by surgeons.

Intervention Type: PROCEDURE

Ultrasound-guided adductor canal block

Procedure: Ultrasound-guided adductor canal and iPACK blocks performed by anesthesiologists preoperatively.

Intervention Type: PROCEDURE

Other Intervention Names

iPACK block

Eligibility Criteria

Inclusion Criteria

1. ASA classification I-III

2. BMI < 35 kg/m2

3. Having elective unilateral total knee arthroplasty

Exclusion Criteria

1. Bilateral knee surgery.

2. Pre-existing neurological deficit or peripheral neuropathy in the lower the lower limbs

3. Severe, poorly controlled cardiac conditions, significant arrhythmias, severe valvular heart diseases

4. Severe, poorly controlled respiratory conditions (severe COPD, severe interstitial lung disease, severe / poorly controlled asthma)

5. Contraindication to regional anesthesia (e.g. bleeding diathesis, coagulopathy, sepsis, infection at the site of potential needle puncture on the posterior chest)

6. Patient refusal

7. Chronic pain disorder

8. Chronic opioid use (≥30 mg oxycodone / day)

9. Contraindication (or allergy) to a component of multi-modal analgesia protocol

10. Allergy to amide local anesthetics used in nerve blocks

11. Contraindications to spinal anesthesia

12. Significant psychiatric disorder that would preclude objective study assessment

13. Pregnancy

14. Inability to provide informed consent

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Women's College Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Richard Brull, MD

Role: PRINCIPAL_INVESTIGATOR

Women's College Hospital

Central Contacts

Didem Bozak

Role: CONTACT

didem.bozak@wchospital.ca

416-323-6008

References

Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, Garnett C, Ranawat AS, Su EP, Mayman DJ, Memtsoudis SG. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg. 2019 Aug;129(2):526-535. doi: 10.1213/ANE.0000000000003794.

Reference Type: BACKGROUND

PMID: 30234517 (View on PubMed)

Other Identifiers

LIA vs. LIA + ACB-iPACK block

Identifier Type: -

Identifier Source: org_study_id