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Comparison of the analgesic and physical recovery effect of genicular nerve block (GNB) alone and (GNB + infiltration between popliteal artery and posterior capsule of the knee (IPACK) in patients undergoing total knee replacement
Comparison of preemptive analgesia of (GNB) with (GNB+ IPACK) on postoperative pain control and recovery of knee physical activity in patient undergoing total knee replacement.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| C group | Active Comparator | the patients will take standard analgesia ( meloxicam (15 mg) once a day + paracetamol 1gm /3 times a day). ,with no nerve block |
|
| G group | Active Comparator | the patients will take standard analgesia plus GNB |
|
| GI group | Active Comparator | the patients will take standard analgesia plus GNB plus IPACK |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| GNB plus standard analgesia | Procedure | When patients are in supine position with a pillow under the popliteal fossa, we will target points next to superior medial, superior lateral, and inferior medial genicular arteries to block the superior medial, superior lateral, and inferior medial branches of genicular nerve. For identification, we will use color Doppler near the periosteal areas (the junctions of the epicondyle with the shafts of the femur and tibia, accordingly). using a 12 MHz linear transducer (XarioTM SSA-660A, Toshiba Medical Systems Corporation, Otawara, Japan) positioned parallel to the shaft of the long bones in the legs, the needle will be inserted ( in plane technique in the long-axis view) and a 2.5 mL of bupivacaine (5%) will be injected at each target points.standard analgesia will be given post-operativelly (paracetamol 1 gm/ three times a daily and meloxicam (15 mg)once a day) |
| Measure | Description | Time Frame |
|---|---|---|
| 2 hours visual analogue scale | pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10". | at 2 hour postoperative. |
| 4 hours visual analogue score | pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10". | at 4 hours postoperative |
| 6 hours visual analogue score | pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10". | at 6 hours postoperative |
| 8 hours visual analogue score | pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10". | at 8 hours postopertaive |
| 12 hours visual analogue score | pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10". | at 12 hours postoperative |
| 18 hours visual analogue score | pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10". |
| Measure | Description | Time Frame |
|---|---|---|
| • Time of performance of block | defined as time from putting of U.S probe till the end of block procedure. | from putting of U.S probe till the end of block procedure |
| • Total morphine consumption |
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Inclusion criteria:
Exclusion criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Heba M Fathi, MD | Contact | 01000143938 | 002 | heba_elgendi@yahoo.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Heba M Fathi | Recruiting | Zagazig | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41318369 | Derived | Fathi HM, Fahmy AM, Shaker MA, Kamel AAF. Comparison of genicular nerve block and its combination with IPACK block for analgesia and recovery after total knee arthroplasty: a randomized trial. BMC Anesthesiol. 2025 Nov 29;25(1):601. doi: 10.1186/s12871-025-03408-0. |
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| GNB plus IPACK block plus standard analgesia | Procedure | IPACK block will be done when the patients in supine position with the knee flexed in 45 degree. using a low frequency transducer at a depth of 3.5-4 cm positioned transversely, 2-3 cm above the patella and over the medial aspect of the knee, we will identify the distal part of the shaft of the femur and the popliteal artery with sliding the transducer proximally and distally (If the two femoral condyles appear first, proximal sliding of the probe, so the humps of the femoral condyles will disappeared and the flat metaphysis will appeared). With advancement of the needle in plane toward the space between the popliteal artery and the femur, 15 ml of bupivacaine 0.5% will be injected. The genicular nerve block will be done as in group G and standard analgesia will be given post-operative as in group G |
|
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| standard analgesia (paracetamol and meloxicam) | Drug | (paracetamol 1 gm 3 times a daily and meloxicam (15 mg) once aday. |
|
|
| at 18 hours postoperative |
| 24 hours visual analogue score | pain intensity at rest and with motion using visual analogue scale from " horizontal line of 10-cm long with two ends, one end indicate no pain 0 and the other end indicate worst pain 10". | at 24 hours postoperative |
Total morphine consumption
| at 24 hours post-operatively |
| •incidence of Anticipated side effect | nausea, vomiting, itching, hemorrhage, bradycardia and hypotension. | at 24,48 hours postoperative |
| degree of maximum active flexion and extension of the knee | the angle of maximum active flexion and extension of the knee | at 24 hours post operative |
| walk test | walking distance in meters that patients can wake during 2 min | at 24 hours post operative |
| holding quadriceps muscle | number of patients capable to hold quadriceps muscle more than 5 seconds. | at 24 hours post operative |
| time up and go (TUG) | the time required for the patient to stand up from a standard-height armchair, walk 3 meters, turn, walk back to the chair, and sit down | at 24 hours post operative |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D000082 | Acetaminophen |
| D000077239 | Meloxicam |
| ID | Term |
|---|---|
| D000083 | Acetanilides |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D013843 | Thiazines |
| D013457 | Sulfur Compounds |
| D013844 | Thiazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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