Effect of Adding Ultrasound Guided IPACK Block to Adductor Canal Block for Postoperative Pain in Knee Tumor Excision

National Cancer Institute, Egypt

Status: Enrolling

Conditions: Cancer Pain

Treatments: Procedure: adductor canal block with iPACK; Other: control group

Study type: Interventional

Funder types: Other

Identifiers

NCT07382297

AP2407-201-011

Details and patient eligibility

About

the aim of this study is to determine the analgesic effect of iPACK in combination to ACB after the excision of tumors around the Knee regarding the following:

• Time to the 1st rescue analgesia.
• Postoperative morphine consumption.
• Postoperative visual analogue scale (VAS). This study will include patients, aged 18 to 65 years, belonging to the American Society of Anesthesiologists (ASA) physical status II to IV , undergoing excision of tumors around the knee under spinal anesthesia.

Patients will be randomly allocated Group iPACK plus Adductor canal block (ACB) : patients will receive ACB plus iPACK block.

• Control group : patients will not receive any block but will take morphine 3mg bolus at VAS more than 4 and regular NSAIDS and paracetamol iv.

Full description

Immediate alleviation of postoperative pain after knee surgeries is critical for patients' postoperative recovery. Ineffective pain management may result in an extended hospital stay and rehabilitation period, as well as the development of chronic pain Non-opioid analgesics are insufficient to alleviate the pain that is intended to be relieved.

Although using Opioids have concerns regarding their potential side effects, which encompass nausea, vomiting, respiratory depression, and addiction Multimodal analgesia, which may include preemptive analgesia, neuraxial blockade, peripheral nerve block, and narcotic and non-narcotic analgesics, is an optimal approach for the management of acute pain following knee surgeries Adductor canal block (ACB) is an interfascial plane infiltration of local anesthetic used to block a portion of the saphenous nerve, which originates in the adductor canal, as well as the obturator nerve ACB combined with an iPACK block results in significantly better postoperative visual analog scale (VAS) scores, knee ranges of motion, as well as ambulation distances compared with ACB alone

Enrollment: 70 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Stated willingness to comply with all study procedures and availability for the duration of the study
• American Society of Anesthesiologists (ASA) physical status II-IV.
• Patients undergoing excision of tumors around the knee under spinal anesthesia

Exclusion criteria

• Patient refusal.
• Neuromuscular disorders
• Allergy to local anesthetics
• Previous history of knee surgery
• Patients with a prior knee infection
• Contraindications to spinal anesthesia as coagulopathies and severe aortic stenosis.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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70 participants in 2 patient groups

adductor canal block with iPACK

Active Comparator group

Description:

The adductor canal will be identified. a spinal needle 22 gauge x 3.5 inches will be advanced with the guidance of ultrasound in an in-plane technique, and 15ml of 0.5% bupivacaine will be injected then IPACK block will be performed The probe will be applied to the popliteal fossa for identification of the popliteal artery and femur. Then, the probe will be slid distally for revealing the two femoral condyles followed by proximal sliding of the probe until the humps of the femoral condyles disappeared and the flat metaphysis appeared. a spinal needle 22G x 3.5 inches will be advanced from the lateral aspect and directed across the space between the popliteal artery and femur and once the needle reaches the medial edge of the femur, nearly at the level of the popliteal artery, negative aspiration will be confirmed and 15ml of 0.5% bupivacaine will be injected incrementally as the needle will be withdrawn.

Treatment:

Procedure: adductor canal block with iPACK

control group

Other group

Description:

visualizing the adductor canal without doing any block for the control group

Treatment:

Other: control group