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LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. The combination of ACB-iPACK blocks has also been proposed as an effective analgesic modality for total knee arthroplasty. However, whether combining these two modalities yields any important incremental analgesic benefit remains unclear. The investigators hypothesized that the addition of ACB and iPACK blocks to LIA will yield clinically important analgesic benefits compared to LIA alone in patients having total knee arthroplasty.
LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. Performed by surgeons, LIA provides effective postoperative pain relief and reduces opioid requirements. Similar analgesic benefits have also been attributed to adductor canal and iPACK blocks, which partially block sensory innervation to the knee and its posterior capsule. Performed by anesthesiologist preoperatively, these blocks have also been incorporated into the care standard in numerous centers. However, it is not clear whether adding the adductor canal and iPACK blocks yields any incremental analgesic benefits. The investigators aimed to evaluate the benefits of adding adductor canal and iPACK blocks to LIA in patients having total knee arthroplasty.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Local infiltration analgesia | Experimental | Patients in this group will receive LIA intraoperatively, as per institutional standard. The injected solution will be comprised of 100cc Ropiv 2%, + Ketorolac 30 mg + Epinephrine 25 ug. |
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| Local infiltration analgesia + ACB-iPACK block | Active Comparator | Patients in this group will receive LIA intraoperatively, as per institutional standard. The injected solution will be comprised of 100cc Ropiv 2%, + Ketorolac 30 mg + Epinephrine 25 ug. Patients in this group will also receive preoperative nerve blocks under ultrasound guidance. These will include:
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Local infiltration analgesia | Procedure | Procedure: Local infiltration analgesia performed by surgeons. |
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| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain at rest | Area under the curve | over the first 24 hours |
| Quality of recovery (QoR-15) | Quality of Recovery (QR15) scores at 24 hours will be the second primary outcome. QR15 is a measurement of quality of recovery after surgery and anesthesia that has been psychometrically tested and validated. Reporting of outcome measures on a scale of 0 to 10 (0=None of the time and 10=All of the time). There are a total of 40 items/questions. | 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Mean opioid analgesic consumption | Postoperative cumulative oral morphine equivalent consumption during the first 24 hours | 24 hours postoperatively |
| Time to first analgesic request | Up to 48 hours following surgery |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Didem Bozak | Contact | 416-323-6008 | didem.bozak@wchospital.ca |
| Name | Affiliation | Role |
|---|---|---|
| Richard Brull, MD | Women's College Hospital | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30234517 | Background | Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, Garnett C, Ranawat AS, Su EP, Mayman DJ, Memtsoudis SG. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg. 2019 Aug;129(2):526-535. doi: 10.1213/ANE.0000000000003794. |
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Randomized, parallel group, triple blind (patient, assessor, anesthesiologist in the operating room)
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| Ultrasound-guided adductor canal block | Procedure | Procedure: Ultrasound-guided adductor canal and iPACK blocks performed by anesthesiologists preoperatively. |
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| Pain Assessment (VAS) | Visual Analogue Scale(VAS) - Pain:Overall pain assessed at rest and on movement A continuous scale comprised of a 100mm (10cm) horizontal line, anchored by 2 verbal descriptions No Pain to Worst Pain | at 0, 6, 12, 18 and 24 hours |
| Risk of opioid-related side effects | nausea, vomiting, pruritus, sedation | Up until one month following nerve block |
| Block-related complications | vascular puncture, hematoma formation, intravascular injection, epidural anesthesia-bilateral sensory block | Up until one month following nerve block |
| Satisfaction with pain management | A Patient Diary will be completed to assess overall satisfaction with analgesic technique 10 cm scale with "not satisfied at all" and "very satisfied" at either end | at 24 hours |