Adductor Canal Block Combined With IPACK vs Genicular Nerves Block in Knee Arthroscopy

Tanta University105 enrolled

Overview

This prospective randomized controlled study is designed to investigate the postoperative analgesic effect of adductor canal block (ACB) combined with infiltration of the interspace between the popliteal artery and the capsule of posterior knee (IPACK) block compared to genicular nerves block in patients undergoing knee arthroscopy.

Maintaining patient safety, ensuring best patient outcomes, and optimal pain relief post-operatively are of utmost concern for anesthesia providers. Adequate pain relief attenuates stress responses and long-term chronic pain complications while contributing to improved postoperative outcomes. Knee arthroscopy is a very common procedure and very often is performed as day-case surgery. Ambulatory arthroscopic surgery of the knee is preferred by the majority of properly selected and well-informed patients. It has been reported that a significant number of patients have moderate to severe pain 24 hours after ambulatory surgery in general and knee arthroscopy in particular and pain affects the patient's activity level and satisfaction. Adductor canal block (ACB) is a popular peripheral nerve block that has been shown to decrease the pain significantly and decrease opioid consumption with minimal effect on quadriceps function. It provides analgesia to the peri-articular and intra-articular aspects of the knee joint but doesn't relieve posterior knee pain which is moderate to severe in intensity.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

105

Conditions

Arthroscopy Genicular Nerves Block

Interventions

Spinal anesthesia onlyPROCEDURE

Patients will receive spinal anesthesia with 2-3 ml 0.5% (10-15 mg) hyperbaric bupivacaine plus 25 ug fentanyl at the L3/4 interspaces.

Spinal anesthesia and ultrasound-guided Genicular nerves blockBIOLOGICAL

Patients will receive16 ml bupivacaine 0025% will be administered, and4 ml of this solution will be placed at each of the 4 target nerves.

Ultrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK)BIOLOGICAL

Eligibility

Sex: ALLMin age: 21 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 21-60 years * Both genders * American Society of Anaesthesiologists physical status classification I - III * Patients scheduled for elective unilateral knee arthroscopy under spinal anesthesia Exclusion Criteria: * Patient refusal * Preoperative neurological deficits * Opioid-dependent (opioid intake more than 3 months) * Chronic pain conditions * Significant cardiac and respiratory disease * Pre-existing major organ dysfunction such as hepatic and renal failure * Coexisting hematological disorder or deranged coagulation parameters * Psychiatric illnesses * Allergy to any of the drugs used in the study

Outcomes

Primary Outcomes

Postoperative 24-hour rescue analgesic consumption

Total postoperative 24-hour rescue analgesic consumption will be recorded

Time frame: 24 hours postoperative

Secondary Outcomes

Post-operative pain

Post-operative pain will be assessed by the Numeric Rating Scale (NRS) rest and mobilization.

Time frame: 24 hours Postoperative

Time taken till 1st rescue analgesic request

The time till administration of first rescue analgesia will be recorded

Time frame: 24 hours Postoperative

Data from ClinicalTrials.gov

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