100 patients ASA I-III, undergoing total knee arthroplasty under spinal anesthesia, will be randomly assigned into one of two groups, namely group A (n=50), where an adductor canal block and an IPACK block will be performed preoperatively and group B (n=50) where an adductor canal block only will be performed preoperatively. All patients will receive a standardized multimodal approach, including pregabalin, paracetamol, and PCA with morphine. NRS scores in static and dynamic conditions during the first 48 hours postoperatively, morphine consumption during the first 24 hours postoperatively will be measured and additionally, patient satisfaction, complications, range of knee motion, moblization, functionality, delirium ocurence will be recorded. Chronic pain will be assessed in 3 and 6 months postoperatively.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
100
Adductor Canal Block plus IPACK Block using Ropivacaine
Adductor Canal Block using Ropivacaine
Asklepieion Hospital of Voula
Athens, Greece
RECRUITINGNRS scores
Numerical Rating Scale (NRS) scores (Range 0-10, 0=no pain, 10=the worse pain ever)
Time frame: 48 hours
Morphine consumption
Morphine consumption in mg
Time frame: 24 hours
Chronic pain
Using of Graded Chronic Pain Scale (GCPS) Grade 0: No pain in prior 6 months Grade 1: Low Intensity - Low Disability Grade II: High Intensity Characteristic Pain Intensity - Low Disability Grade III: High Disability - Moderately Limiting Grade IV: High Disability - Severely Limiting
Time frame: 6 months
Delirium occurence
Nu-DESK scale (presence of disorientation, inappropriate behavior, inappropriate communication,illusions/hallucinations, psychomoter retardation). Each of the 5 items is rated from 0 to 2. A total of 10 is the maximum score. A score of more than 2 identifies the presence of delirium.
Time frame: 48 hours
Range of knee motion
Degrees of flexion
Time frame: 48 hours
Complications
Time frame: 48 hours
Patient mobilization
Patient reporting time of first standing to the side of the bed and number of steps per day
Time frame: 5 days
Patient satisfaction
Patients asked whether they would choose the same anaesthetic management in a future operation: Yes/No
Time frame: 48 hours
Joint function
Maximal flexion / extension
Time frame: 6 months
Intestinal function
Time of first passing of rectal gas, reported by the patient
Time frame: 5 days
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