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Effect of Erector Spinae Plane Block and iPACK block with Adductor Canal Block on pain management, and NLR and PLR following knee arthroplasty
Knee arthroplasty is one of the most common orthopedic procedures, especially in elderly patients, due to the deformation of joints. Patients may complain of severe pain due to surgical trauma and prosthesis. Regional anesthesia methods may be performed to reduce the inflammatory response, opioid consumption, and opioid-related side effects.
In recent years, the influence of regional anesthesiology on reducing the inflammatory response after surgical procedures has been emphasized. However, very few studies have evaluated the effect of various methods of anesthesia on the NLR.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Placebo | Placebo Comparator | Only spinal anaesthesia - No peripheral nerve block |
|
| Erector Spinae Plane Block | Active Comparator | spinal anaesthesia and unilateral ultrasound guided erector spinae plane block - 20ml 0.2% ropivacaine |
|
| Infiltration Popliteal Artery and Capsule of the Knee and Adductor Canal Block | Active Comparator | spinal anaesthesia and ultrasound guided Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee (iPACK) block - 20ml 0.2% ropivacaine + ultrasound guided Adductor Canal Block - 10ml 0.2% ropivacaine |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Control Test - spinal anesthesia | Drug | No peripheral nerve block Only spinal anesthesia |
|
| Measure | Description | Time Frame |
|---|---|---|
| Opioid consumption | Total opiate consumption after surgery | 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| first need of opiate | Time after surgery when the patient needs opiate for the first time | 48 hours |
| Numerical Rating Scale [range 0:10] | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Malgorzata Domagalska, Ph.D. | Poznan University of Medical Science | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Poznan University of Medical Sciences | Poznan | Poland |
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| Ropivacaine 0.2% Injectable Solution ESPB | Drug | ultrasound guided erector spinae plane block (ESPB) - L2 level, unilateral |
|
|
| Ropivacaine 0.2% Injectable Solution iPACK+ACB | Drug | ultrasound guided iPACK block + Adductor Canal Block |
|
|
| 4 hours after surgery |
| Numerical Rating Scale [range 0:10] | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) | 8 hours after surgery |
| Numerical Rating Scale [range 0:10] | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) | 12 hours after surgery |
| Numerical Rating Scale [range 0:10] | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) | 16 hours after surgery |
| Numerical Rating Scale [range 0:10] | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) | 20 hours after surgery |
| Numerical Rating Scale [range 0:10] | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) | 24 hours after surgery |
| NLR | Neutrophil-to-lymphocyte ratio | 24 hours postoperatively |
| PLR | Platelet-to-lymphocyte ratio | 24 hours postoperatively |
| Quadriceps muscle strength assessed using medical research council scale [range 0:5] | Quadriceps muscle strength (knee extension and hip adduction) will be evaluated according to the medical research council muscle strength rating | 24 hours after surgery |
| ID | Term |
|---|---|
| D020370 | Osteoarthritis, Knee |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
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| ID | Term |
|---|---|
| D000775 | Anesthesia, Spinal |
| D000077212 | Ropivacaine |
| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
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