IPACK Block Versus Adductor Canal Block in High Tibeal Osteotomy

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

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

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

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