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This prospective, comparative study aims to evaluate the postoperative analgesic efficacy of ultrasound-guided Adductor Canal Block (ACB) combined with iPACK block versus Femoral Triangle Block (FTB) combined with selective tibial nerve block and obturator nerve block in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. The primary objective is to determine which regional anesthesia regimen provides superior pain relief at rest and during movement. The secondary objectives include assessing morphine consumption, motor blockade using the Bromage score, patient satisfaction, and potential adverse effects of these anesthesia techniques.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ACB and iPACK Block Group | Experimental | Ultrasound-guided Adductor Canal Block (10ml levobupivacaine 0.2%) and iPACK block (15ml levobupivacaine 0.2%) combined with standard multimodal analgesia (Paracetamol + Diclofenac). |
|
| FTB, Tibial and Obturator Blocks Group | Active Comparator | Ultrasound-guided Femoral Triangle Block (10ml levobupivacaine 0.2%), selective Tibial Nerve Block (5ml levobupivacaine 0.2%), and Obturator Nerve Block (10ml levobupivacaine 0.2%) combined with standard multimodal analgesia |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound-guided Adductor Canal Block (ACB) | Procedure | Ultrasound-guided administration of 10 mL levobupivacaine 0.2% into the adductor canal space to provide postoperative analgesia |
| Measure | Description | Time Frame |
|---|---|---|
| Visual Analog Scale (VAS) for Pain at Rest and Movement | Evaluating pain scores using the Visual Analog Scale (VAS) at rest and during knee flexion at 0, 1, 3, 6, 9, 12, 18, and 24 hours postoperatively | Within the first 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Total Rescue Morphine Consumption | Within the first 24 hours postoperatively | |
| Motor Blockade Assessment using Bromage Score | Within the first 24 hours postoperatively | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nhan Trong Phan, MD. MSc | Contact | +84856271294 | dr.phantrongnhan@gmail.com | |
| Trong Nhan Phan | Contact | dr.phantrongnhan@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Nhan T Phan, MD. MSc | Da Nang Hospital | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40269716 | Result | Bai S, Hu A, Li W, Chen Y, Li X, Song X, Liu D, Ba Y, Chen Q, Liu X, Li Y, Zhang H, Xie Y, Wang X. Comparing the analgesic effects of femoral triangle block and adductor canal block following total knee arthroplasty: a systematic review and meta-analysis. BMC Anesthesiol. 2025 Apr 23;25(1):202. doi: 10.1186/s12871-025-03073-3. | |
| 23241723 |
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| Ultrasound-guided iPACK block | Procedure | Ultrasound-guided administration of 15 mL levobupivacaine 0.2% into the space between the popliteal artery and the posterior capsule of the knee to provide posterior knee analgesia. |
|
| Ultrasound-guided Femoral Triangle Block (FTB) | Procedure | Ultrasound-guided administration of 10 mL levobupivacaine 0.2% at the distal apex of the femoral triangle to provide anterior and medial knee analgesia |
|
| Ultrasound-guided Selective Tibial Nerve Block | Procedure | Ultrasound-guided administration of 5 mL levobupivacaine 0.2% around the tibial nerve in the popliteal fossa |
|
| Ultrasound-guided Obturator Nerve Block | Procedure | Ultrasound-guided administration of 10 mL levobupivacaine 0.2% targeting the anterior and posterior branches of the obturator nerve within the fascial planes between the adductor muscles. |
|
| Patient Satisfaction Score |
| 24 hours postoperatively |
| Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013 Feb;118(2):409-15. doi: 10.1097/ALN.0b013e318279fa0b. |
| 30104837 | Result | Ghodki PS, Shalu PS, Sardesai SP. Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia. J Anaesthesiol Clin Pharmacol. 2018 Apr-Jun;34(2):242-246. doi: 10.4103/joacp.JOACP_172_17. |
| ID | Term |
|---|---|
| D000070598 | Anterior Cruciate Ligament Injuries |
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
| 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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