LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. The combination of ACB-iPACK blocks has also been proposed as an effective analgesic modality for total knee arthroplasty. However, whether combining these two modalities yields any important incremental analgesic benefit remains unclear. The investigators hypothesized that the addition of ACB and iPACK blocks to LIA will yield clinically important analgesic benefits compared to LIA alone in patients having total knee arthroplasty.
LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. Performed by surgeons, LIA provides effective postoperative pain relief and reduces opioid requirements. Similar analgesic benefits have also been attributed to adductor canal and iPACK blocks, which partially block sensory innervation to the knee and its posterior capsule. Performed by anesthesiologist preoperatively, these blocks have also been incorporated into the care standard in numerous centers. However, it is not clear whether adding the adductor canal and iPACK blocks yields any incremental analgesic benefits. The investigators aimed to evaluate the benefits of adding adductor canal and iPACK blocks to LIA in patients having total knee arthroplasty.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
60
Procedure: Local infiltration analgesia performed by surgeons.
Procedure: Ultrasound-guided adductor canal and iPACK blocks performed by anesthesiologists preoperatively.
Postoperative pain at rest
Area under the curve
Time frame: over the first 24 hours
Quality of recovery (QoR-15)
Quality of Recovery (QR15) scores at 24 hours will be the second primary outcome. QR15 is a measurement of quality of recovery after surgery and anesthesia that has been psychometrically tested and validated. Reporting of outcome measures on a scale of 0 to 10 (0=None of the time and 10=All of the time). There are a total of 40 items/questions.
Time frame: 24 hours postoperatively
Mean opioid analgesic consumption
Postoperative cumulative oral morphine equivalent consumption during the first 24 hours
Time frame: 24 hours postoperatively
Time to first analgesic request
Time frame: Up to 48 hours following surgery
Pain Assessment (VAS)
Visual Analogue Scale(VAS) - Pain:Overall pain assessed at rest and on movement A continuous scale comprised of a 100mm (10cm) horizontal line, anchored by 2 verbal descriptions No Pain to Worst Pain
Time frame: at 0, 6, 12, 18 and 24 hours
Risk of opioid-related side effects
nausea, vomiting, pruritus, sedation
Time frame: Up until one month following nerve block
Block-related complications
vascular puncture, hematoma formation, intravascular injection, epidural anesthesia-bilateral sensory block
Time frame: Up until one month following nerve block
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Satisfaction with pain management
A Patient Diary will be completed to assess overall satisfaction with analgesic technique 10 cm scale with "not satisfied at all" and "very satisfied" at either end
Time frame: at 24 hours