"The Effect of Dexamethasone Administration Route on Pain and Inflammatory Response in iPACK With ACB for Total Knee Arthroplasty" - written in plain language according to ClinicalTrials.gov standards: The goal of this clinical trial is to learn how the route of dexamethasone administration (either through the vein or nerve block) affects pain and inflammation in people having total knee replacement surgery. All participants will receive two types of nerve blocks before surgery: an iPACK block and an adductor canal block (ACB), which help control pain after the operation. The main questions the study aims to answer are: Does injecting dexamethasone into the nerve block reduce pain more effectively than giving it by vein? Which method leads to a lower inflammatory response after surgery? Researchers will compare the two groups to see which route offers better pain relief and less swelling after knee surgery. Participants will: Be randomly assigned to receive dexamethasone either in the nerve block or by IV Receive standard care for total knee replacement Rate their pain and have blood tests after surgery to measure inflammation
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
90
iPACK block with Adductor Canal Block (2 x 20ml 0.2% ropivacaine + 1ml 0.9% NaCl) + 2ml 0.9% NaCl iv
iPACK block with Adductor Canal Block (2 x 20ml 0.2% ropivacaine + 1ml 0.9% NaCl) + 4mg Dexamethasone iv
iPACK block with Adductor Canal Block (2 x 20ml 0.2% ropivacaine + 2mg Dexamethasone) + 2ml 0.9% NaCl iv
Poznan University of Medical Sciences
Poznan, Poland
Time to first rescue analgesia
Time to first rescue analgesia
Time frame: Time Frame: 48 hours after surgery
Total opioid consumption
Total opioid consumption (mg) converted to morphine milligram equivalents (MME)
Time frame: 48 hours after surgery
NRS
umeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")
Time frame: 4 hours after surgery
NRS
umeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")
Time frame: 8 hours after surgery
NRS
umeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")
Time frame: 12 hours after surgery
NRS
umeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")
Time frame: 24 hours after surgery
NRS
umeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")
Time frame: 48 hours after surgery
NLR
Neutrophil-to-lymphocyte ratio
Time frame: 12 hours after surgery
NLR
Neutrophil-to-lymphocyte ratio
Time frame: 24 hours after surgery
NLR
Neutrophil-to-lymphocyte ratio
Time frame: 48 hours after surgery
PLR
Platelet-to-lymphocyte ratio
Time frame: 12 hours after surgery
PLR
Platelet-to-lymphocyte ratio
Time frame: 24 hours after surgery
PLR
Platelet-to-lymphocyte ratio
Time frame: 48 hours after surgery
Quadriceps muscle strength assessed using medical research council scale [range 0:5]
Quadriceps muscle strength, including knee extension and hip adduction, will be evaluated using the Medical Research Council (MRC) muscle strength grading scale, where higher scores indicate better muscle strength
Time frame: 4 hours after surgery
Quadriceps muscle strength assessed using medical research council scale [range 0:5]
Quadriceps muscle strength, including knee extension and hip adduction, will be evaluated using the Medical Research Council (MRC) muscle strength grading scale, where higher scores indicate better muscle strength
Time frame: 8 hours after surgery
Quadriceps muscle strength assessed using medical research council scale [range 0:5]
Quadriceps muscle strength, including knee extension and hip adduction, will be evaluated using the Medical Research Council (MRC) muscle strength grading scale, where higher scores indicate better muscle strength
Time frame: 12 hours after surgery
Quadriceps muscle strength assessed using medical research council scale [range 0:5]
Quadriceps muscle strength, including knee extension and hip adduction, will be evaluated using the Medical Research Council (MRC) muscle strength grading scale, where higher scores indicate better muscle strength
Time frame: 24 hours after surgery
Quadriceps muscle strength assessed using medical research council scale [range 0:5]
Quadriceps muscle strength, including knee extension and hip adduction, will be evaluated using the Medical Research Council (MRC) muscle strength grading scale, where higher scores indicate better muscle strength
Time frame: 48 hours after surgery
Nerve damage
Nerve damage assessment will be performed using the following grading scale: N0 - No nerve damage N1 - Minor: sensory paresthesia N2 - Major: complete sensory anesthesia N3 - Complete: complete motor deficit with or without paresthesia N4 - CRPS: Complex Regional Pain Syndrome
Time frame: 12 hours after surgery
Nerve damage
Nerve damage assessment will be performed using the following grading scale: N0 - No nerve damage N1 - Minor: sensory paresthesia N2 - Major: complete sensory anesthesia N3 - Complete: complete motor deficit with or without paresthesia N4 - CRPS: Complex Regional Pain Syndrome
Time frame: 24 hours after surgery
Nerve damage
Nerve damage assessment will be performed using the following grading scale: N0 - No nerve damage N1 - Minor: sensory paresthesia N2 - Major: complete sensory anesthesia N3 - Complete: complete motor deficit with or without paresthesia N4 - CRPS: Complex Regional Pain Syndrome
Time frame: 48 hours after surgery
glucose
blood glucose level
Time frame: 12 hours after surgery
glucose
blood glucose level
Time frame: 24 hours after surgery
glucose
blood glucose level
Time frame: 48 hours after surgery
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