Evaluation of Utility of Ultrasound Guided iPACK Block for Knee Extension After Total Knee Arthroplasty.

Duke University50 enrolled

Overview

The purpose of this study is to learn if using an Interspace between the Popliteal Artery and Capsule of the Knee (iPACK) injection technique (also called a "nerve block") that numbs the nerves going to the back part of the knee to aid in physical therapy after surgery. The iPACK technique uses a numbing solution (local anesthetics) that is injected behind the knee to reduce pain and to help straighten the knee. This block may affect movement in the leg and make the legs weak, but thing is rare. A few institutions use the iPACK block for patients having total knee replacements, with the hope of providing good pain relief combined with improved mobility after surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

Conditions

Knee Osteoarthritis Primary Total Knee Arthroplasty Physical Therapy Pain

Interventions

RopivacaineDRUG

Local anesthetic (numbing drug)

Interspace Between the Popliteal Artery and Capsule of the Knee (iPACK) BlockPROCEDURE

An ultrasound guided nerve block using a numbing medication called ropivacaine that numbs the nerves to the back of the knee.

SalineDRUG

An ultrasound guided nerve block using a medication that does NOT numb the nerve called saline, or salt water.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * English speaking * Between 18 and 75 years old * American Society of Anesthesiologists (ASA) 1-3 patients undergoing primary total knee arthroplasty Exclusion Criteria: * ASA 4 or 5 * Revision knee arthroplasty * Diagnosis of chronic pain * Daily chronic opioid use (over 3 months of continuous opioid use) * Inability to communicate pain scores or need for analgesia * Acute knee dislocation/fracture * Infection at the site of block placement * Age under 18 years old or greater than 75 years old * Pregnant women * Intolerance/allergy to local anesthetics * Weight \<50 kg * Suspected, or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past 2 years. * Uncontrolled anxiety, schizophrenia, or other psychiatric disorder that, in the opinion of the investigator, may interfere with study assessments or compliance * Current or historical evidence of any clinically significant disease or condition that, in the opinion of the investigator, may increase the risk of surgery or complicate the subject's postoperative course.

Outcomes

Primary Outcomes

Number of Participants Able to Hyperextend the Knee After Surgery

Ability to hyperextend the knee after surgery

Time frame: Within 8 hours

Secondary Outcomes

Ambulation as Measured by Distance Walked After Surgery

Time frame: Post-operative Day 0

Pain as Measure by Numerical Rating Scale (NRS) 11

The 11-point numeric rating scale ranges from 0 ("no pain") to 10 ("worst pain imaginable").

Time frame: 24 hours

Cumulative Opioid Consumption

Total amount of opioids used