This study aims to investigate the effect of femoral triangle block combined with popliteal plexus block and distal IPACK block on postoperative pain after total knee arthroplasty (TKA)
Popliteal Plexus Block (PPB) is a new nerve block technique that has been shown to anaesthetise nerves involved in the innervation of the posterior part of the knee joint. The IPACK (interspace between the popliteal artery and capsule of the posterior knee) block is a regional anesthesia technique in which a local anesthetic is infiltrated under ultrasound guidance between the popliteal artery and the capsule of the posterior knee. This technique blocks the branches of the obturator nerve, the common peroneal nerve, and the tibial nerve in the popliteal region. In the context of knee arthroplasty, the application of the IPACK block has been associated with lower scores for ambulatory pain, lower scores for resting pain, and reduced morphine consumption. Although both techniques of blockade seem to be efficient in the context of analgesia for the posterior part of the knee after TKA. No study compares these two blocks as part of multimodal analgesia to provide pain relief after TKA. This study aimed to evaluate the analgesic effect of PPB or distal IPACK, in addition to femoral triangle block, as a component of a multimodal analgesic regimen after TKA.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
120
Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for PPB
Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for distal iPACK
Karaman Training and Research Hospital, Karaman, Karaman 70200
Karaman, Karaman, Turkey (Türkiye)
RECRUITINGOpioid consumption
Total opioid consumption in each group, A, B until 24 hours postoperative.
Time frame: 24 hours
NRS scores
Numerical Rating Scale (NRS) scores (Range 0-10, 0=no pain, 10=the worse pain ever)
Time frame: 48 hours
Range of knee motion
Degrees of flexion
Time frame: 48 hours
Patient mobilization
Patient reporting time of first standing to the side of the bed and time up and go test 2 days
Time frame: 48 hours
Post-block Maximum Voluntary Isometric Contraction (MVIC) by knee extension, calculated as a percentage of the Pre-block baseline value
Both MVIC test are assessed preoperative, using a handheld dynamometer
Time frame: A 60-minute interval is between pre-block and post-block MVIC assessments
Post-block MVIC by ankle plantarflexion, calculated as a percentage of the Pre-block baseline value
Both MVIC tests are assessed preoperative, using a handheld dynamometer
Time frame: A 60-minute interval is between pre-block and post-block MVIC assessments
Post-block MVIC by ankle dorsiflexion, calculated as a percentage of the Pre-block baseline value
Both MVIC tests are assessed preoperative, using a handheld dynamometer
Time frame: A 60 minutes interval is between pre-block and post-block MVIC assessments
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Muscle strength of knee extension, graded by Manual Muscle Test (MMT)
Grade 3: Able to extend the knee in active Range of Motion (ROM) against gravity, Grade 2: Patient is lying on the side, with knee resting on the bed, able to extend the knee in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the quadriceps muscle is palpable or observable but the knee does not extend, Grade 0: No muscle contraction of the quadriceps muscle is palpable or observable
Time frame: Assessed pre-block, post-block (60 minutes after pre-block), and postoperative 5 hours
Muscle strength of ankle plantarflexion, graded by MMT
Grade 3: Able to plantarflex in active ROM, Grade 2: Patient is lying on the side, with ankle resting on the bed, able to plantarflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the gastrocnemius muscle is palpable or observable but the ankle does not plantarflex, Grade 0: No muscle contraction of the gastrocnemius muscle is palpable or observable
Time frame: Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours
Muscle strength of ankle dorsiflexion, graded by MMT
Grade 3: Able to dorsiflex in active ROM Grade 2: Patient is lying on the side, with ankle resting on the bed, able to dorsiflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the tibialis anterior muscle is palpable or observable but the ankle does not dorsiflex, Grade 0: No muscle contraction of the tibialis anterior muscle is palpable or observable
Time frame: Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours
Incidence of rebound pain
Rebound pain is described as severe pain (NRS ≥ 7)
Time frame: Postoperative 24 hours
Quality of Recovery 15 Score
Quality of Recovery (QoR)-15 survey.Minimum value: 0, Maximum value: 150, higher scores mean better.
Time frame: Postoperative Day 1