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This prospective randomized controlled study is designed to investigate the postoperative analgesic effect of adductor canal block (ACB) combined with infiltration of the interspace between the popliteal artery and the capsule of posterior knee (IPACK) block compared to genicular nerves block in patients undergoing knee arthroscopy.
Maintaining patient safety, ensuring best patient outcomes, and optimal pain relief post-operatively are of utmost concern for anesthesia providers. Adequate pain relief attenuates stress responses and long-term chronic pain complications while contributing to improved postoperative outcomes.
Knee arthroscopy is a very common procedure and very often is performed as day-case surgery. Ambulatory arthroscopic surgery of the knee is preferred by the majority of properly selected and well-informed patients. It has been reported that a significant number of patients have moderate to severe pain 24 hours after ambulatory surgery in general and knee arthroscopy in particular and pain affects the patient's activity level and satisfaction. Adductor canal block (ACB) is a popular peripheral nerve block that has been shown to decrease the pain significantly and decrease opioid consumption with minimal effect on quadriceps function. It provides analgesia to the peri-articular and intra-articular aspects of the knee joint but doesn't relieve posterior knee pain which is moderate to severe in intensity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| spinal anesthesia only | Experimental | Patients will receive spinal anesthesia only |
|
| spinal anesthesia and ultrasound-guided Genicular nerves block | Experimental | Patients will receive spinal anesthesia and ultrasound-guided Genicular nerves block |
|
| Spinal anesthesia and US guided Adductor canal nerve block plus infiltration of the interspace | Experimental | Patients will receive spinal anesthesia and ultrasound-guided Adductor canal nerve block plus infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (PACK) block. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Spinal anesthesia only | Procedure | Patients will receive spinal anesthesia with 2-3 ml 0.5% (10-15 mg) hyperbaric bupivacaine plus 25 ug fentanyl at the L3/4 interspaces. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative 24-hour rescue analgesic consumption | Total postoperative 24-hour rescue analgesic consumption will be recorded | 24 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| Post-operative pain | Post-operative pain will be assessed by the Numeric Rating Scale (NRS) rest and mobilization. | 24 hours Postoperative |
| Time taken till 1st rescue analgesic request | The time till administration of first rescue analgesia will be recorded |
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Inclusion Criteria:
Exclusion Criteria:
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The data will be available under a reasonable request from the corresponding author
One year after the end of the study
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| Spinal anesthesia and ultrasound-guided Genicular nerves block | Biological | Patients will receive16 ml bupivacaine 0025% will be administered, and4 ml of this solution will be placed at each of the 4 target nerves. |
|
| Ultrasound-guided Adductor Canal block (ACB) technique with infiltration of the interspace between popliteal artery and the capsule of posterior knee block ('PACK) | Biological | Adductor Canal block (ACB) technique will be performed using 16 ml bupivacaine 0025% As regarding the Popliteal artery and the capsule of posterior knee block ('PACK), it will be performed Using 16 ml bupivacaine 0.25% |
|
| 24 hours Postoperative |
| ID | Term |
|---|---|
| D000775 | Anesthesia, Spinal |
| D008722 | Methods |
| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D008919 | Investigative Techniques |
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