Continuous Adductor Canal Block (CACB) Combined With İnfiltration Between the Popliteal Artery and Capsule of the Knee (iPACK) Block vs Continuous Adductor Canal Block Alone After Total Knee Arthroplasty
Comparison of the Effects of iPACK Block Combined With Continuous Adductor Canal Block Versus Continuous Adductor Canal Block Alone on Postoperative Analgesia, Early Mobilization, and Length of Hospital Stay in Total Knee Arthroplasty Cases
This study compares the effects of adding an infiltration between the popliteal artery and capsule of the knee (iPACK) block to a continuous adductor canal block (CACB) versus continuous adductor canal block alone on postoperative analgesia, opioid consumption, early mobilization, and length of hospital stay in patients undergoing total knee arthroplasty. This is a prospective, randomized, double-blind study with 54 patients allocated 1:1 into two groups.
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Severe postoperative pain occurs in up to 58% of patients after total knee arthroplasty. Peripheral nerve blocks are an effective component of multimodal analgesia, and the continuous adductor canal block (CACB) has become a preferred technique because it provides sensory blockade while sparing motor function of the quadriceps, allowing earlier ambulation compared to femoral nerve block. However, CACB does not address posterior knee pain, which can be targeted by the iPACK (infiltration between the popliteal artery and capsule of the knee) block, a technique that blocks terminal sensory branches of the tibial and peroneal nerves without motor blockade.
In this study, patients scheduled for total knee arthroplasty will be randomized 1:1 (using randomizer.org) to receive either CACB alone (Group 2) or CACB combined with a single-injection iPACK block (Group 1). CACB will be maintained via a perineural catheter connected to a patient-controlled analgesia (PCA) pump delivering 0.1% bupivacaine. Rescue analgesia will be provided with intravenous tramadol (50 mg, max 300 mg/day) when the numeric rating scale (NRS) pain score exceeds 4.
Pain scores (NRS 0-10), total analgesic and opioid consumption, hemodynamic parameters, time to first mobilization (assessed via the Timed Up and Go test), patient satisfaction, and length of hospital stay will be recorded at baseline and at 1, 3, 6, 12, and 24 hours postoperatively by an anesthesiologist blinded to group allocation, different from the anesthesiologist who performed the block.
Undersøgelsestype
Tilmelding (Anslået)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
- Navn: Muzaffer GENCER, MD
- Telefonnummer: 905059436459
- E-mail: dr.m.gencer07@gmail.com
Undersøgelse Kontakt Backup
- Navn: Furkan TONTU, MD
- Telefonnummer: 905465771656
- E-mail: furkantontu@gmail.com
Studiesteder
-
-
Istanbul
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Başakşehir, Istanbul, Tyrkiet (Türkiye), 34480
- Basaksehir Çam Ve Sakura City Hospital, İstanbul, Türkiye
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Kontakt:
- Muzaffer GENCER, MD
- Telefonnummer: 905059436459
- E-mail: dr.m.gencer07@gmail.com
-
Kontakt:
- Murat Y MERSİN, MD
- Telefonnummer: 905367736432
- E-mail: myasinmersin@gmail.com
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Ledende efterforsker:
- Furkan TONTU, MD
-
Underforsker:
- Muzaffer GENCER, MD
-
Underforsker:
- Murat Y Mersin, MD
-
-
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Patients of either sex
- Aged 18 to 75 years
- American Society of Anesthesiologists (ASA) physical status I, II, or III
- Voluntary participation
- Fully oriented and able to cooperate with postoperative assessments
Exclusion Criteria:
- ASA physical status IV or V
- Patients who decline to participate
- Pediatric patients
- Active infection at the block site
- Chronic pain or regular analgesic use
- Coagulation disorders
- Inability to cooperate with postoperative pain assessment
- Known allergy to local anesthetics
- Neuropathy or myopathy in the operated extremity
- Revision arthroplasty cases
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Dobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Group 1 (CACB + iPACK)
Continuous adductor canal block (catheter, PCA with 0.1% bupivacaine) plus a single-injection iPACK block (0.25% bupivacaine 20 mL) |
Single injection of 0.25% bupivacaine 20 mL between the popliteal artery and posterior knee capsule, performed under ultrasound guidance Perineural catheter placement in the adductor canal with PCA-delivered 0.1% bupivacaine (5-7 mL basal rate, 5 mL bolus, 30-min lockout) for 24 hours postoperatively |
|
Aktiv komparator: Group 2 (CACB Alone)
Continuous adductor canal block alone (catheter, PCA with 0.1% bupivacaine) |
Perineural catheter placement in the adductor canal with PCA-delivered 0.1% bupivacaine (5-7 mL basal rate, 5 mL bolus, 30-min lockout) for 24 hours postoperatively |
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Postoperative Pain Score (Numeric Rating Scale)
Tidsramme: Baseline and postoperative hours 1, 3, 6, 12, and 24
|
Pain intensity assessed using the Numeric Rating Scale (NRS, 0-10; 0 = no pain, 10 = worst pain imaginable) |
Baseline and postoperative hours 1, 3, 6, 12, and 24
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Total Opioid Consumption
Tidsramme: Postoperative 24 hours
|
Total rescue analgesic (tramadol) consumption via intravenous (IV) administration |
Postoperative 24 hours
|
|
Total Local Anesthetic Consumption
Tidsramme: Postoperative 24 hours
|
Total bupivacaine consumed via patient-controlled analgesia (PCA) pump |
Postoperative 24 hours
|
|
Time to First Mobilization
Tidsramme: Postoperative 24 hours
|
Time to first unassisted ambulation/movement, assessed via the Timed Up and Go (TUG) test |
Postoperative 24 hours
|
|
Length of Hospital Stay
Tidsramme: From surgery to discharge (up to approximately 1 week)
|
Number of days from surgery to discharge |
From surgery to discharge (up to approximately 1 week)
|
|
Patient Satisfaction Score
Tidsramme: Postoperative 24 hours
|
Satisfaction rated on a 4-point scale (1 = not satisfied, 2 = Slightly satisfied, 3 = Satisfied, 4 = very satisfied) |
Postoperative 24 hours
|
|
Systolic Blood Pressure
Tidsramme: Baseline and postoperative hours 1, 3, 6, 12, and 24
|
Systolic blood pressure measured in mmHg |
Baseline and postoperative hours 1, 3, 6, 12, and 24
|
|
Diastolic Blood Pressure
Tidsramme: Baseline and postoperative hours 1, 3, 6, 12, and 24
|
Diastolic blood pressure measured in mmHg |
Baseline and postoperative hours 1, 3, 6, 12, and 24
|
|
Mean Arterial Blood Pressure
Tidsramme: Baseline and postoperative hours 1, 3, 6, 12, and 24
|
Mean arterial blood pressure (MAP) measured in mmHg |
Baseline and postoperative hours 1, 3, 6, 12, and 24
|
|
Heart Rate
Tidsramme: Baseline and postoperative hours 1, 3, 6, 12, and 24
|
Heart rate measured in beats per minute |
Baseline and postoperative hours 1, 3, 6, 12, and 24
|
|
Peripheral Oxygen Saturation
Tidsramme: Baseline and postoperative hours 1, 3, 6, 12, and 24
|
Peripheral oxygen saturation (SpO2) measured as a percentage |
Baseline and postoperative hours 1, 3, 6, 12, and 24
|
|
Block-Related Complications
Tidsramme: Throughout study participation (up to 24 hours postoperatively)
|
Incidence of complications associated with the regional block techniques (e.g., nerve injury, infection) |
Throughout study participation (up to 24 hours postoperatively)
|
Samarbejdspartnere og efterforskere
Efterforskere
- Ledende efterforsker: Furkan TONTU, MD, BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ
- Studieleder: Muzaffer GENCER, MD, BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİ
- Studieleder: Murat Y Mersin, MD, BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR HASTANESİt
Publikationer og nyttige links
Generelle publikationer
- Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Park BY. Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty. Clin Orthop Surg. 2017 Sep;9(3):303-309. doi: 10.4055/cios.2017.9.3.303. Epub 2017 Aug 4.
- Diz Protezi Ameliyatı Sonrası Sürekli Adduktör Kanal Bloğuna Popliteal Arter ve Diz Kapsülü Arası İnfiltrasyon Bloğunun (IPACK) Eklenmesinin Etkisi DOI: 10.1080/11101849.2023.2246732
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Primær færdiggørelse (Anslået)
Studieafslutning (Anslået)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- BSH-ANES-MYM-02
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Individual participant data will not be shared beyond what is reported in publications resulting from this study.
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