Analgesic Efficacy of Anterior Femoral, Genicular and Adductor Canal Nerve Block

NCT02548104 | Completed

• 1 other identifier: CSMCPro00034213
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

Recently, more distal approach to femoral nerve branches (saphenous) in the adductor canal in the medial compartment of the thigh have shown to provide comparable anesthesia and analgesia without quadriceps muscle weakness than traditional femoral nerve blocks (FNB) after total knee arthroplasty (TKA). Adductor canal block (ACB) has the unique advantage of providing localized analgesia to the peripatellar and intra-articular aspects of the knee joint without reducing the patient's ability to perform a straight leg raise. However, it does not adequately address the incisional pain component on the anterior surface of the knee innervated by anterior femoral cutaneous nerve. This pain may be improved by addition of the anterior femoral block (AFB). Additionally, the ACB does not provide analgesia to the posterior aspect of the knee, which is commonly moderate to severe after surgery. This pain may be decreased by addition of the genicular block, also known as the iPACK block (interspace between the popliteal artery and the capsule of the knee). There is no study that has evaluated the potentially analgesic benefits of the AFB or the iPACK block combined with ACB after TKA. Therefore, the investigators designed this randomized, prospective, and double-blinded study to assess our hypothesis that the addition of the AFB and/or iPACK block to the ACB will improve analgesic effects, decrease pain scores, deceased opioid requirement, and as well as facilitate early recovery and improve patient satisfaction with pain management in patient after TKA.

Conditions

Pain, Postoperative

Outcome Measures

Primary Outcomes (2)

• Changes of pain scores (VRS) at rest

  Verbal rating scale (VRS) scores: 0 = none to 10 = intolerable pain.

  Post-op day 1,2,3

• Changes of pain scores (VRS) at motion activity

  Verbal rating scale (VRS) scores: 0 = none to 10 = intolerable pain.

  Post-op day 1,2,3

Secondary Outcomes (6)

• Patient satisfaction score

  Post-op day 1

• Patient satisfaction score

  Post-op day 2

• Patient satisfaction score

  Post-op day 3

• Gait distance

  Post-op day 1

• Gait distance

  Post-op day 2

Study Arms (2)

Adductor canal block (ACB)

ACTIVE COMPARATOR

Group I Adductor canal block (ACB): 0.25% bupivacaine with 1:200,000 epinephrine 30 ml and ultrasound-guided genicular (IPACK) with normal saline 15 ml

Other: ACB

Adductor canal ACB + genicular (IPACK)

EXPERIMENTAL

Group II Adductor canal block (ACB): 0.25% bupivacaine with 1:200,000 epinephrine 30 ml and ultrasound-guided genicular (IPACK) with 0.25% Bupivicaine with 1:200,000 epinephrine 15 ml

Other: ACB + iPACK

Interventions

ACB OTHER

ultrasound-guided ACB with 0.25% Bupivicaine with 1:200,000 epinephrine 30 ml and ultrasound-guided genicular (IPACK) with normal saline 15 ml

Adductor canal block (ACB)

ACB + iPACK OTHER

ultrasound-guided ACB with 0.25% Bupivicaine with 1:200,000 epinephrine 30 ml and ultrasound-guided genicular (IPACK) with 0.25% Bupivicaine with 1:200,000 epinephrine 15 ml

Adductor canal ACB + genicular (IPACK)

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18-90 yrs
• The American Society of Anesthesiologists (ASA) Physical Status 1-3
• Either gender

You may not qualify if:

• Refusal to participate in the study
• Age\< 18 yrs, or\> 90 yrs
• General anesthesia
• Bilateral TKA, or revision of TKA
• Contraindications to regional blockage including but not limited to:
• Patient refusal to regional blockade
• Infection at the site of needle insertion
• Systemic infection
• Bleeding diathesis or coagulopathy (as diagnosed by history or laboratory evaluation)

Sponsors & Collaborators

• Cedars-Sinai Medical Center: lead

Study Sites (1)

Cedars Sinai Medical Center

Los Angeles, California, 90048, United States

Location

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Study Officials

• Roya Yumul, M.D.,PhD.

  Department of Anesthesiology

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Department of anesthesiology

Study Record Dates

• First Submitted: September 8, 2015
• First Posted: September 14, 2015
• Study Start: October 1, 2017
• Primary Completion: November 6, 2023
• Study Completion: November 6, 2023
• Last Updated: June 19, 2025

Record last verified: 2025-06

Locations

US (1)