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

Analgesic Effect of Adductor Canal Block Combined With Infiltration of the Interspace Between Popliteal Artery and the Capsule of the Knee (IPACK) Block Versus Genicular Nerves Block in Knee Arthroscopy

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Arthroscopy; Genicular Nerves Block
• Intervention / Treatment: Procedure: Spinal anesthesia only; Biological: Spinal anesthesia and ultrasound-guided Genicular nerves block; Biological: Ultrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK)

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.

• Study Type: Interventional
• Enrollment (Anticipated): 105
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: spinal anesthesia only; Patients will receive spinal anesthesia only	Procedure: 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.
Experimental: spinal anesthesia and ultrasound-guided Genicular nerves block; Patients will receive spinal anesthesia and ultrasound-guided Genicular nerves block	Biological: 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.
Experimental: 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.	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%

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative 24-hour rescue analgesic consumption	Total postoperative 24-hour rescue analgesic consumption will be recorded	24 hours postoperative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-operative pain	Post-operative pain will be assessed by the Numeric Rating Scale (NRS) rest and mobilization.	24 hours Postoperative
Time taken till 1st rescue analgesic request	The time till administration of first rescue analgesia will be recorded	24 hours Postoperative

Collaborators and Investigators

• Sponsor: Tanta University

Study record dates

Study Major Dates

• Study Start (Anticipated): March 21, 2022
• Primary Completion (Anticipated): March 20, 2023
• Study Completion (Anticipated): March 21, 2023

Study Registration Dates

• First Submitted: March 4, 2022
• First Submitted That Met QC Criteria: March 4, 2022
• First Posted (Actual): March 7, 2022

Study Record Updates

• Last Update Posted (Actual): March 24, 2022
• Last Update Submitted That Met QC Criteria: March 8, 2022
• Last Verified: March 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Central Nervous System Depressants; Anesthetics
• Other Study ID Numbers: 35236/1/22

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available under a reasonable request from the corresponding author
• IPD Sharing Time Frame: One year after the end of the study
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No