Postoperative Analgesic Efficacy of ACB+iPACK vs FTB+Selective Tibial+Obturator Blocks in ACL Reconstruction (ACL-Analgesia)

Evaluation of Postoperative Analgesic Efficacy in Anterior Cruciate Ligament Reconstruction: Ultrasound-Guided Adductor Canal Block Combined With iPACK Block Versus Femoral Triangle Block Combined With Selective Tibial and Obturator Nerve Blocks at Da Nang Hospital

This prospective, comparative study aims to evaluate the postoperative analgesic efficacy of ultrasound-guided Adductor Canal Block (ACB) combined with iPACK block versus Femoral Triangle Block (FTB) combined with selective tibial nerve block and obturator nerve block in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. The primary objective is to determine which regional anesthesia regimen provides superior pain relief at rest and during movement. The secondary objectives include assessing morphine consumption, motor blockade using the Bromage score, patient satisfaction, and potential adverse effects of these anesthesia techniques.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain; Anterior Cruciate Ligament Injuries
• Intervention / Treatment: Procedure: Ultrasound-guided Adductor Canal Block (ACB); Procedure: Ultrasound-guided iPACK block; Procedure: Ultrasound-guided Femoral Triangle Block (FTB); Procedure: Ultrasound-guided Selective Tibial Nerve Block; Procedure: Ultrasound-guided Obturator Nerve Block

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nhan Trong Phan, MD. MSc; Phone Number: +84856271294; Email: dr.phantrongnhan@gmail.com
• Study Contact Backup: Name: Trong Nhan Phan; Email: dr.phantrongnhan@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 16 years and older
• Patients undergoing elective arthroscopic anterior cruciate ligament (ACL) reconstruction
• ASA physical status I-II
• Indicated for spinal anesthesia
• Provided informed consent

Exclusion Criteria:

• Infection at the injection site
• Spinal cord or lower limb nerve injury
• Contraindications to regional anesthesia (Levobupivacaine)
• Known allergy to Paracetamol or Diclofenac
• Coagulopathy

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ACB and iPACK Block Group; Ultrasound-guided Adductor Canal Block (10ml levobupivacaine 0.2%) and iPACK block (15ml levobupivacaine 0.2%) combined with standard multimodal analgesia (Paracetamol + Diclofenac).	Procedure: Ultrasound-guided Adductor Canal Block (ACB); Ultrasound-guided administration of 10 mL levobupivacaine 0.2% into the adductor canal space to provide postoperative analgesia; Procedure: Ultrasound-guided iPACK block; Ultrasound-guided administration of 15 mL levobupivacaine 0.2% into the space between the popliteal artery and the posterior capsule of the knee to provide posterior knee analgesia.
Active Comparator: FTB, Tibial and Obturator Blocks Group; Ultrasound-guided Femoral Triangle Block (10ml levobupivacaine 0.2%), selective Tibial Nerve Block (5ml levobupivacaine 0.2%), and Obturator Nerve Block (10ml levobupivacaine 0.2%) combined with standard multimodal analgesia	Procedure: Ultrasound-guided Femoral Triangle Block (FTB); Ultrasound-guided administration of 10 mL levobupivacaine 0.2% at the distal apex of the femoral triangle to provide anterior and medial knee analgesia; Procedure: Ultrasound-guided Selective Tibial Nerve Block; Ultrasound-guided administration of 5 mL levobupivacaine 0.2% around the tibial nerve in the popliteal fossa; Procedure: Ultrasound-guided Obturator Nerve Block; Ultrasound-guided administration of 10 mL levobupivacaine 0.2% targeting the anterior and posterior branches of the obturator nerve within the fascial planes between the adductor muscles.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale (VAS) for Pain at Rest and Movement	Evaluating pain scores using the Visual Analog Scale (VAS) at rest and during knee flexion at 0, 1, 3, 6, 9, 12, 18, and 24 hours postoperatively	Within the first 24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Time Frame
Total Rescue Morphine Consumption	Within the first 24 hours postoperatively
Motor Blockade Assessment using Bromage Score	Within the first 24 hours postoperatively
Patient Satisfaction Score	24 hours postoperatively

Collaborators and Investigators

• Sponsor: Da Nang Hospital
• Investigators: Principal Investigator: Nhan T Phan, MD. MSc, Da Nang Hospital

Publications and helpful links

General Publications

• Bai S, Hu A, Li W, Chen Y, Li X, Song X, Liu D, Ba Y, Chen Q, Liu X, Li Y, Zhang H, Xie Y, Wang X. Comparing the analgesic effects of femoral triangle block and adductor canal block following total knee arthroplasty: a systematic review and meta-analysis. BMC Anesthesiol. 2025 Apr 23;25(1):202. doi: 10.1186/s12871-025-03073-3.
• Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013 Feb;118(2):409-15. doi: 10.1097/ALN.0b013e318279fa0b.
• Ghodki PS, Shalu PS, Sardesai SP. Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia. J Anaesthesiol Clin Pharmacol. 2018 Apr-Jun;34(2):242-246. doi: 10.4103/joacp.JOACP_172_17.

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: July 8, 2026
• First Submitted That Met QC Criteria: July 8, 2026
• First Posted (Actual): July 14, 2026

Study Record Updates

• Last Update Posted (Actual): July 14, 2026
• Last Update Submitted That Met QC Criteria: July 8, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Adductor Canal Block; Knee Arthroscopy; iPACK Block; Femoral Triangle Block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Wounds and Injuries; Postoperative Complications; Pathologic Processes; Leg Injuries; Knee Injuries; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Anterior Cruciate Ligament Injuries; Pain, Postoperative
• Other Study ID Numbers: 2026.15.171

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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