An adequate balance between analgesia and motor function is an essential requirement to facilitate functional recovery and early discharge after anterior cruciate ligament (ACL) reconstruction surgery. Proximal nerve blocks (i.e. femoral and sciatic nerve blocks) are associated with optimal analgesia, but they can cause muscle weakness, interfering with rehabilitation and increasing the risk of falls . A recent randomized controlled trial concluded that, compared to mid-and distal ACB, a distal femoral triangle block (FTB) is associated with lower opioid consumption and improved postoperative analgesia for ambulatory ACL reconstruction. In ACL reconstruction surgery there are other potential sources of pain not covered by a FTB, such as intra-articular structures (menisci, cruciate ligaments), posterior knee capsule and the graft donor site. Evidence supporting the addition of an IPACK block to a FTB has been studied for patients undergoing total knee replacement, nonetheless, there is no trial analyzing the analgesic contribution of IPACK to a FTB in the context of ACL reconstruction surgery. In this multicentric trial, the investigators set out to analyze the analgesic benefit of adding an IPACK block to a FTB.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
48
Ultrasound-guided Femoral Triangle block with 20 mL of Bupivacaine 0.25% and IPACK block with 20 mL of Bupivacaine 0.25%
Ultrasound-guided Femoral Triangle block with 20 mL of Bupivacaine 0.25% and IPACK block with 20 mL of normal saline 0.9%
Clinica Alemana de Santiago
Santiago, RM, Chile
ACTIVE_NOT_RECRUITINGHospital Clinico Universidad de Chile
Santiago, RM, Chile
RECRUITINGPost-operative pain scores at 2 hours of arrival to Post Anesthesia Care Unit (PACU)
Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points
Time frame: 2 hours after arrival to PACU
Post-operative static pain scores at 0 hours of arrival to PACU
Pain evaluated at rest in Numeric Rating Score from 0 to 10 points
Time frame: 0 hours after arrival to PACU
Post-operative static pain scores at PACU discharge
Pain evaluated at rest in Numeric Rating Score from 0 to 10 points
Time frame: at discharge of PACU up to 2 hours postoperatively
Post-operative static pain scores at 6 hours of arrival to PACU
Pain evaluated at rest in Numeric Rating Score from 0 to 10 points
Time frame: 6 hours after arrival to PACU
Post-operative static pain scores at 12 hours of arrival to PACU
Pain evaluated at rest in Numeric Rating Score from 0 to 10 points
Time frame: 12 hours after arrival to PACU
Post-operative static pain scores at 24 hours of arrival to PACU
Pain evaluated at rest in Numeric Rating Score from 0 to 10 points
Time frame: 24 hours after arrival to PACU
Post-operative dynamic pain scores at 0 hours of arrival to PACU
Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points
Time frame: 0 hours after arrival to PACU
Post-operative dynamic pain scores at PACU discharge
Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points
Time frame: at discharge of PACU up to 2 hours postoperatively
Post-operative dynamic pain scores at 6 hours of arrival to PACU
Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points
Time frame: 6 hours after arrival to PACU
Post-operative dynamic pain scores at 12 hours of arrival to PACU
Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points
Time frame: 12 hours after arrival to PACU
Post-operative dynamic pain scores at 24 hours of arrival to PACU
Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points
Time frame: 24 hours after arrival to PACU
Femoral Triangle Block success assessment at 2 hours
Sensory block will be assessed with ice on the medial leg
Time frame: 2 hours after arrival to PACU
Incidence of opioid related adverse events
Incidence of adverse events related to opioid use (nausea/vomiting, pruritus, somnolence, respiratory depression, urinary retention)
Time frame: 24 hours after arrival to PACU
Intraoperative opioid consumption
Total opioid use during intraoperative period
Time frame: From anesthesia induction to extubation
PACU opioid consumption
total opioid consumption during PACU stay
Time frame: from PACU arrival to discharge up to 2 hours postoperatively
Total opioid consumption
Total opioid consumption
Time frame: 6 hours, 12 hours and 24 hours after PACU arrival
Nerve block complications
Incidence of nerve block complications (vascular puncture, puncture site erythema, hematoma, foot drop, LAST)
Time frame: From nerve block performance up to 24 hours after PACU arrival
Lower limb tourniquet
lower limb tourniquet duration
Time frame: from inflation of pneumatic device to tourniquet release
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