IPACK Block Versus Adductor Canal Block in High Tibeal Osteotomy

Overview

A comparison between IPACK block and adductor canal block in post operative pain management

Full Title of Study: “Infiltration of Local Anesthetic in the Interspace Between the Popliteal Artery and Capsule of the Posterior Knee “IPACK Block” Versus Adductor Canal Block “ACB” for Pain Relief After Open Wedge High Tibial Osteotomy”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: February 2023

Detailed Description

Two groups of patients between 40 and 60 yrs who are undergoing open wedge high tibeal osteotomy Group 1 will receive IPACK block with 15 ml Bupivacaine, immediately before spinal anaesthesia . Group 2 will receive adductor canal block ,also with 15 ml Bupivacaine. before spinal anaesthesia. register the time of first pain sensation and firs IV analgesic dose required in each group

Interventions

  • Procedure: Infiltration of local anaesthetic between popliteal artery and posterior knee capsule
    • Adductor canal block (ACB) is a popular peripheral nerve block that has been shown to decrease pain significantly and thereby opioid consumption with minimal effect on quadriceps function [8]. Though ACB provides analgesia to the peripatellar and intra-articular aspect of knee joint, it does not relieve posterior knee pain which is moderate to severe in intensity [9, 10]. The recent technique of an ultrasound (US)-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown to provide significant posterior knee analgesia without affecting the common peroneal nerve (CPN) [11]. We postulated that IPACK will provide better pain relief and improve knee function in the immediate postoperative period compared to ACB

Arms, Groups and Cohorts

  • Active Comparator: Group 1 who will receive IPACK block
    • This group of patients will receive IPACK block immediately before spinal anaesthesia then follow up for 24 hrs to register first pain sensation and analgesic requirements
  • Active Comparator: Group 2 who will receive adductor canal block
    • This group of patients will receive adductor canal block immediately before spinal anaesthesia then follow up for 24 hrs to register first pain sensation and analgesic requirements

Clinical Trial Outcome Measures

Primary Measures

  • the time of first pain sensation requiring analgesia
    • Time Frame: 24 hours
    • If intervention which is adductor canal block or lPACK block is effective in postoperative pain control that can decrease the lV analgesic agents

Participating in This Clinical Trial

Inclusion Criteria

1. Age 40 – 60 years. 2. American Society of Anesthiologist class ( ASA) I – III 3. BMI 18-35 kg/m2 4. Scheduled for primary unilateral open wedge high tibial osteotomy Exclusion Criteria:

1. Known allergy to local anesthetics 2. Contraindication to local anesthetics injection e.g. infection at the site of injection 3. Contraindication to spinal anesthesia e.g. coagulopathy. 4. Patients with pre-existing motor or sensory deficits in lower extremities. 5. Insulin or noninsulin dependent diabetes mellitus. 6. systemic corticosteroid use within 30-days of surgery 7. difficulties in comprehending visual analog scale (VAS) pain scores 8. history of arrhythmia or seizures 9. severe renal insufficiency

Gender Eligibility: All

Minimum Age: 40 Years

Maximum Age: 60 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Assiut University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Salwa Hussein Ahmed Hussein, Assistant lecturer – Assiut University
  • Overall Official(s)
    • Salwa Hussein, Lecturer, Principal Investigator, Assiut University
  • Overall Contact(s)
    • Salwa Hussein, 01159460234, salwa94hussien@gmail.com

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