Adductor Canal Block Combined With IPACK vs Genicular Nerves Block in Knee Arthroscopy

NCT ID: NCT05269095

Last Updated: 2022-03-24

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 105 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-03-21
• Study Completion Date: 2023-03-21

Brief Summary

This prospective randomized controlled study is designed to investigate the postoperative analgesic effect of adductor canal block (ACB) combined with infiltration of the interspace between the popliteal artery and the capsule of posterior knee (IPACK) block compared to genicular nerves block in patients undergoing knee arthroscopy.

Detailed Description

Maintaining patient safety, ensuring best patient outcomes, and optimal pain relief post-operatively are of utmost concern for anesthesia providers. Adequate pain relief attenuates stress responses and long-term chronic pain complications while contributing to improved postoperative outcomes.

Knee arthroscopy is a very common procedure and very often is performed as day-case surgery. Ambulatory arthroscopic surgery of the knee is preferred by the majority of properly selected and well-informed patients. It has been reported that a significant number of patients have moderate to severe pain 24 hours after ambulatory surgery in general and knee arthroscopy in particular and pain affects the patient's activity level and satisfaction. Adductor canal block (ACB) is a popular peripheral nerve block that has been shown to decrease the pain significantly and decrease opioid consumption with minimal effect on quadriceps function. It provides analgesia to the peri-articular and intra-articular aspects of the knee joint but doesn't relieve posterior knee pain which is moderate to severe in intensity.

Conditions

Arthroscopy; Genicular Nerves Block

Study Design

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

Study Groups

spinal anesthesia only

Patients will receive spinal anesthesia only

Group Type: EXPERIMENTAL

Spinal anesthesia only

Intervention Type: PROCEDURE

Patients will receive spinal anesthesia with 2-3 ml 0.5% (10-15 mg) hyperbaric bupivacaine plus 25 ug fentanyl at the L3/4 interspaces.

spinal anesthesia and ultrasound-guided Genicular nerves block

Patients will receive spinal anesthesia and ultrasound-guided Genicular nerves block

Group Type: EXPERIMENTAL

Spinal anesthesia and ultrasound-guided Genicular nerves block

Intervention Type: BIOLOGICAL

Patients will receive16 ml bupivacaine 0025% will be administered, and4 ml of this solution will be placed at each of the 4 target nerves.

Spinal anesthesia and US guided Adductor canal nerve block plus infiltration of the interspace

Patients will receive spinal anesthesia and ultrasound-guided Adductor canal nerve block plus infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (PACK) block.

Group Type: EXPERIMENTAL

Ultrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK)

Intervention Type: BIOLOGICAL

Adductor Canal block (ACB) technique will be performed using 16 ml bupivacaine 0025% As regarding the Popliteal artery and the capsule of posterior knee block ('PACK), it will be performed Using 16 ml bupivacaine 0.25%

Interventions

Spinal anesthesia only

Patients will receive spinal anesthesia with 2-3 ml 0.5% (10-15 mg) hyperbaric bupivacaine plus 25 ug fentanyl at the L3/4 interspaces.

Intervention Type: PROCEDURE

Spinal anesthesia and ultrasound-guided Genicular nerves block

Patients will receive16 ml bupivacaine 0025% will be administered, and4 ml of this solution will be placed at each of the 4 target nerves.

Intervention Type: BIOLOGICAL

Ultrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK)

Adductor Canal block (ACB) technique will be performed using 16 ml bupivacaine 0025% As regarding the Popliteal artery and the capsule of posterior knee block ('PACK), it will be performed Using 16 ml bupivacaine 0.25%

Intervention Type: BIOLOGICAL

Eligibility Criteria

Inclusion Criteria

• Age 21-60 years
• Both genders
• American Society of Anaesthesiologists physical status classification I - III
• Patients scheduled for elective unilateral knee arthroscopy under spinal anesthesia

Exclusion Criteria

• Patient refusal
• Preoperative neurological deficits
• Opioid-dependent (opioid intake more than 3 months)
• Chronic pain conditions
• Significant cardiac and respiratory disease
• Pre-existing major organ dysfunction such as hepatic and renal failure
• Coexisting hematological disorder or deranged coagulation parameters
• Psychiatric illnesses
• Allergy to any of the drugs used in the study

• Minimum Eligible Age: 21 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Tanta University

OTHER

Sponsor Role: lead

Responsible Party

Muhammad Ahmed Kandil

Resident of Anesthesiology and Surgical Intensive Care and Pain Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Other Identifiers

35236/1/22

Identifier Type: -

Identifier Source: org_study_id