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This study aims to investigate the effect of femoral triangle block combined with popliteal plexus block and distal IPACK block on postoperative pain after total knee arthroplasty (TKA)
Popliteal Plexus Block (PPB) is a new nerve block technique that has been shown to anaesthetise nerves involved in the innervation of the posterior part of the knee joint.
The IPACK (interspace between the popliteal artery and capsule of the posterior knee) block is a regional anesthesia technique in which a local anesthetic is infiltrated under ultrasound guidance between the popliteal artery and the capsule of the posterior knee. This technique blocks the branches of the obturator nerve, the common peroneal nerve, and the tibial nerve in the popliteal region. In the context of knee arthroplasty, the application of the IPACK block has been associated with lower scores for ambulatory pain, lower scores for resting pain, and reduced morphine consumption.
Although both techniques of blockade seem to be efficient in the context of analgesia for the posterior part of the knee after TKA. No study compares these two blocks as part of multimodal analgesia to provide pain relief after TKA.
This study aimed to evaluate the analgesic effect of PPB or distal IPACK, in addition to femoral triangle block, as a component of a multimodal analgesic regimen after TKA.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group Popliteal plexus block | Experimental | femoral triangle block and popliteal plexus block |
|
| Group distal iPACK | Experimental | Femoral triangle block and distal iPACK |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| femoral triangle block and popliteal plexus block | Device | Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for PPB |
|
| Measure | Description | Time Frame |
|---|---|---|
| Opioid consumption | Total opioid consumption in each group, A, B until 24 hours postoperative. | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| NRS scores | Numerical Rating Scale (NRS) scores (Range 0-10, 0=no pain, 10=the worse pain ever) | 48 hours |
| Range of knee motion | Degrees of flexion |
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Inclusion Criteria:
Exclusion Criteria:
18 Years and older (Adult, Older Adult)
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Tayfun Et | Contact | +905063670717 | drtayfunet@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Karaman Training and Research Hospital, Karaman, Karaman 70200 | Recruiting | Karaman | 70200 | Turkey (Türkiye) |
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| Femoral triangle block and distal iPACK | Device | Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for distal iPACK |
|
| 48 hours |
| Patient mobilization | Patient reporting time of first standing to the side of the bed and time up and go test 2 days | 48 hours |
| Post-block Maximum Voluntary Isometric Contraction (MVIC) by knee extension, calculated as a percentage of the Pre-block baseline value | Both MVIC test are assessed preoperative, using a handheld dynamometer | A 60-minute interval is between pre-block and post-block MVIC assessments |
| Post-block MVIC by ankle plantarflexion, calculated as a percentage of the Pre-block baseline value | Both MVIC tests are assessed preoperative, using a handheld dynamometer | A 60-minute interval is between pre-block and post-block MVIC assessments |
| Post-block MVIC by ankle dorsiflexion, calculated as a percentage of the Pre-block baseline value | Both MVIC tests are assessed preoperative, using a handheld dynamometer | A 60 minutes interval is between pre-block and post-block MVIC assessments |
| Muscle strength of knee extension, graded by Manual Muscle Test (MMT) | Grade 3: Able to extend the knee in active Range of Motion (ROM) against gravity, Grade 2: Patient is lying on the side, with knee resting on the bed, able to extend the knee in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the quadriceps muscle is palpable or observable but the knee does not extend, Grade 0: No muscle contraction of the quadriceps muscle is palpable or observable | Assessed pre-block, post-block (60 minutes after pre-block), and postoperative 5 hours |
| Muscle strength of ankle plantarflexion, graded by MMT | Grade 3: Able to plantarflex in active ROM, Grade 2: Patient is lying on the side, with ankle resting on the bed, able to plantarflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the gastrocnemius muscle is palpable or observable but the ankle does not plantarflex, Grade 0: No muscle contraction of the gastrocnemius muscle is palpable or observable | Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours |
| Muscle strength of ankle dorsiflexion, graded by MMT | Grade 3: Able to dorsiflex in active ROM Grade 2: Patient is lying on the side, with ankle resting on the bed, able to dorsiflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the tibialis anterior muscle is palpable or observable but the ankle does not dorsiflex, Grade 0: No muscle contraction of the tibialis anterior muscle is palpable or observable | Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours |
| Incidence of rebound pain | Rebound pain is described as severe pain (NRS ≥ 7) | Postoperative 24 hours |
| Quality of Recovery 15 Score | Quality of Recovery (QoR)-15 survey.Minimum value: 0, Maximum value: 150, higher scores mean better. | Postoperative Day 1 |