Genicular vs IPACK Block for Analgesia in Knee Arthroplasty

NCT ID: NCT07171931

Last Updated: 2025-09-15

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 72 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-09-15
• Study Completion Date: 2026-04-01

Brief Summary

Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures, and with the aging population, the global number of TKA cases is expected to increase sixfold within the next decade. Postoperative pain following TKA is often severe and difficult to manage, which may increase the risk of developing chronic pain. Effective pain control is therefore a major concern, and multimodal analgesia is recommended to enhance analgesia, reduce opioid consumption, and minimize opioid-related side effects.

Peripheral nerve blocks (PNBs) are an integral part of multimodal regimens. Among them, the adductor canal block (ACB), which provides analgesia to the anteromedial aspect of the knee while preserving motor function, is widely used. The optimal analgesic strategy for TKA should not only ensure adequate pain relief but also maintain quadriceps strength to allow early mobilization. Motor-sparing blocks combined with multimodal analgesia have become increasingly popular because they facilitate early rehabilitation, decrease opioid requirements, and improve recovery outcomes.

The knee joint has a complex innervation, receiving contributions from the femoral, sciatic, and obturator nerves. For this reason, combining different PNBs may provide superior analgesia compared to a single block (2). The genicular nerves, consisting of branches from the femoral, common peroneal, saphenous, tibial, and obturator nerves, innervate the knee capsule. Genicular nerve block specifically targets these branches and has been used to manage postoperative pain in TKA patients.

Another motor-sparing option is the interspace between the popliteal artery and posterior capsule of the knee (IPACK) block, which provides analgesia to the posterior aspect of the knee. Using ultrasound guidance, local anesthetic is deposited between the posterior capsule and the popliteal artery. This approach spares the main trunks of the tibial and common peroneal nerves while effectively blocking the terminal branches innervating the posterior capsule, including the genicular nerves and the popliteal plexus.

However, there are no studies in the literature directly comparing IPACK and genicular blocks. With this study, the investigators aim to compare the efficacy of these two blocks in patients undergoing TKA.

Conditions

Postoperative Pain Management in Total Knee Arthroplasty

Study Design

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

Study Groups

IPACK Group

Patients who will receive IPACK block

Group Type: ACTIVE_COMPARATOR

IPACK block

Intervention Type: PROCEDURE

After the general anesthesia induction, IPACK block will be performed with 0.25% bupivacaine (20 mL) using ultrasound in addition to adductor canal block.

Genicular Group

Patients who will receive genicular block

Group Type: ACTIVE_COMPARATOR

Genicular nerve block with bupivacaine

Intervention Type: PROCEDURE

After the general anesthesia induction, genicular block will be performed with 0.25% bupivacaine (20 mL) using ultrasound in addition to adductor canal block.

Interventions

IPACK block

After the general anesthesia induction, IPACK block will be performed with 0.25% bupivacaine (20 mL) using ultrasound in addition to adductor canal block.

Intervention Type: PROCEDURE

Genicular nerve block with bupivacaine

After the general anesthesia induction, genicular block will be performed with 0.25% bupivacaine (20 mL) using ultrasound in addition to adductor canal block.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Patients undergoing unilateral total knee arthroplasty
• ASA physical status I-III

Exclusion Criteria

• BMI > 35
• Patients < 50 kg
• Allergy to study medications

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Kocaeli University

OTHER

Sponsor Role: lead

Responsible Party

Hadi Ufuk Yörükoğlu

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Hadi Ufuk Yörükoğlu

Role: PRINCIPAL_INVESTIGATOR

Kocaeli University

Central Contacts

Hadi Ufuk Yörükoğlu

Role: CONTACT

ufukyorukoglu@gmail.com

+902623038248

Other Identifiers

KAD-FR-42

Identifier Type: -

Identifier Source: org_study_id