Adductor Canal Block With IPACK Versus 4-in-1 Block for Postoperative Analgesia in Knee Surgery

Zagazig University24 enrolled

Overview

This randomized interventional study compares the analgesic efficacy of Adductor Canal Block combined with Infiltration of the Posterior Capsule of the Knee (IPCAK) versus the 4-in-1 block technique in patients undergoing knee surgery. Twenty-four patients were randomly allocated into two equal groups. The primary objective is to compare postoperative pain scores and analgesic requirements. Secondary outcomes include time to first rescue analgesia, total analgesic consumption, motor function preservation, and block-related complications.

Effective postoperative pain control following knee surgery is essential for early mobilization, rehabilitation, and patient satisfaction. Several regional anesthesia techniques have been developed to provide analgesia while preserving quadriceps muscle strength. Adductor Canal Block combined with Infiltration of the Posterior Capsule of the Knee (IPCAK) has been proposed as a motor-sparing technique that provides effective anterior and posterior knee analgesia. The 4-in-1 block is another ultrasound-guided regional anesthesia technique designed to provide comprehensive analgesia for knee surgery. This prospective randomized interventional study enrolled 24 patients undergoing knee surgery. Participants were randomly assigned to receive either Adductor Canal Block with IPCAK or the 4-in-1 block. Postoperative pain scores, time to first rescue analgesia, total analgesic consumption, motor function, patient satisfaction, and complications were evaluated and compared between the two groups

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Eligibility

Sex: ALLMin age: 21 YearsMax age: 64 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * 1\. Patients or caregivers acceptance. 2. Age : 21 - 64 years 3. Sex : both ( males \& females). 4. Physical status: ASA І \& II. 5. BMI 18.5-30 kg/m2. 6. Type of operations : elective surgery. 7. Type of anesthesia: unilateral intrathecal anesthesia. 8. Patients undergoing elective knee surgery under unilateral spinal anesthesia 9. Duration of surgery within 2 hr. Exclusion Criteria: * Known history of allergy to study drug Coagulopathies or taking drugs affecting coagulation.. Contraindications for peripheral nerve block (PNB) and spinal anesthesia (SA) (coagulation defects, infection at the puncture site), bone degenerative disease and posttraumatic condition of the spine, dementia and severe visual or auditory disorder. Current severe psychiatric disease, alcoholism or drug dependence. Subjects with history previous knee surgery, osteoarthritis, malformation or tumors (including Baker's cyst), which could alter the normal anatomy of the popliteal fossa

Outcomes

Primary Outcomes

Postoperative pain intensity measured by Visual Analog Scale (VAS)

Postoperative pain will be assessed using the Visual Analog Scale (VAS) at rest and during movement at predetermined postoperative time points

Time frame: 24 hours after surgery

Secondary Outcomes

Total opioid consumption

Total rescue opioid analgesic consumption during the first 24 postoperative hours

Time frame: First 24 hours after surgery

Time to first rescue analgesia

Time from completion of surgery to the first request for rescue analgesia

Time frame: Within 24 hours after surgery

Patient satisfaction with postoperative analgesia

Patient satisfaction score regarding postoperative pain management