Multimodal Analgesia Methods in Patients Undergoing IPACK Block in Knee Arthroplasty

Ankara Diskapi Training and Research Hospital70 enrolled

Overview

A comparison of two pain control methods - the combination of Adductor Canal Block (ACB)/Infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (IPACK) versus the Periarticular Injection (PAI)/ Infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (IPACK) - in patients undergoing total knee arthroplasty. dexketoprofen and paracetamol will be added to both groups and multimodal analgesia will be applied. Primary outcome is NRS pain scores with ambulation on postoperative day one (24 hours post-block administration).

Postoperative pain after total knee arthroplasty is serious and difficult to management. Multimodal analgesia recommended for the pain management. For these reasons, we planned a study involving two multimodal analgesia regimens. Patients who will undergo total knee arthroplasty will receive preemptive oral analgesic (dexketofrofen) 1 hour before the operation. Surgery will be initiated after spinal anesthesia is applied to the patients. Two pain control methods - the combination of Adductor Canal Block (ACB)/Infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (IPACK) versus the Periarticular Injection (PAI)/ IPACK- will be applied at the end of the surgery. dexketoprofenand paracetamol will be added to both groups and multimodal analgesia will be applied. Primary outcome is NRS pain scores with ambulation on postoperative day one (24 hours post-block administration).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Interventions

Dexketoprofen TrometamolDRUG

Drug: Dexketoprofen Trometamol oral tablet

spinal anesthesiaOTHER

Drug: heavy bupivacaine 2,5 ml 0,5%

IPACKOTHER

Drug: bupivacaine 20 ml 0,025%

PAIOTHER

Drug: bupivacaine 30 ml 0,025%

Adductor canal blockOTHER

Drug: bupivacaine 20 ml 0,025%

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with osteoarthritis scheduled for a primary either partial or total knee arthroplasty with a participating surgeon * Age 18 to 80 years * Planned use of regional anesthesia * Ability to follow study protocol * Patients of participating surgeons Exclusion Criteria: * Hepatic or renal insufficiency * Younger than 18 years old and older than 80 * Patients undergoing general anesthesia * Allergy or intolerance to one of the study medications * BMI \> 40 * Diabetes * ASA of IV * Chronic gabapentin/pregabalin use (regular use for longer than 3 months) * Chronic opioid use (taking opioids for longer than 3 months, or daily oral morphine equivalent of \>5mg/day for one month)

Outcomes

Primary Outcomes

NRS Pain Scores

NRS Pain scores with ambulation 24 hours post block administration.All patients' postoperative pain numerical rating scale (NRS-numeric rating scale; 0 = absence of pain, 10 = unbearable pain) will be recorded in both groups.

Time frame: 24 hours post block administration

Secondary Outcomes

NRS at Rest and with movement

NRS at rest and with movement at different intervals. All patients' postoperative pain numerical rating scale (NRS-numeric rating scale; 0 = absence of pain, 10 = unbearable pain) will be recorded in both groups.

Time frame: 24 hours on Post-Operative Day 1

Patient Satisfaction with Pain Control using the likert scale

Satisfaction with Pain control at different intervals. 1-5 (according to patient satisfaction)

Time frame: Post-Operative 24 hours