Sciatic Nerve Block, Adductor Canal Block, or IPACK Block

NCT05684107 | Unknown

• 1 other identifier: 10/2022ANETH2
• Study Type: interventional
• Target: 150
• Locations: 1 country
• Sites: 1

Brief Summary

Comparison between local anesthetic infiltration between the popliteal artery and the capsule of the knee (IPACK) versus adductor canal block (ACB) or sciatic nerve block (anterior approach) in combination with femoral nerve block for postoperative analgesia in major knee surgeries.

Conditions

Post Operative Pain

Keywords

IPACK , Sciatic nerve block , adductor canal block

Outcome Measures

Primary Outcomes (1)

• change of visual analogue scale

  a scale from 0 to 10 as the patient will be asked to express his pain on the scale higher scale means a worse outcome

  change from 0 level every 1 hour for 1st 6 hours,then every 4 hours for next 24 hours and on movement

Secondary Outcomes (2)

• time for fisrt analgesic request

  up to 48 hours

• total morphine consumption

  up to 48 hours

Study Arms (3)

IPACK block

ACTIVE COMPARATOR

Procedure: IPACK block

sciatic nerve block

ACTIVE COMPARATOR

Procedure: sciatic nerve block

adductor canal block

ACTIVE COMPARATOR

Procedure: adductor canal block

Interventions

IPACK block PROCEDURE

the probe is applied to the popliteal fossa for identification of the popliteal artery and femur. Then, the probe is slid distally for revealing the two femoral condyles followed by proximal sliding of the probe until the humps of the femoral condyles disappeared and the flat metaphysis appeared. a spinal needle 22G x 3.5 inches is advanced from the lateral aspect and directed across the space between the popliteal artery and femur and once the needle reached the medial edge of the femur, nearly at the level of the popliteal artery, negative aspiration is confirmed and 20 ml of bupivacaine 0.25% is injected incrementally as the needle was withdrawn

IPACK block

adductor canal block PROCEDURE

the transducer is placed anteromedially, approximately at the junction between the middle and distal third of the thigh or somewhat lower. The saphenous nerve block should be performed at the most distal level where the artery still lies immediately deep to the sartorius muscle, thus minimizing the amount of motor nerve block of the vastus medialis; an adductor canal nerve block is typically performed more proximally, around the mid-thigh level. The needle is inserted in-plane in a lateral-to-medial orientation and advanced toward the femoral artery. Once the needle tip is visualized anterior to the artery and after careful aspiration, 20 ml of bupivacaine 0.25% is injected incrementally as the needle was withdrawn

adductor canal block

sciatic nerve block PROCEDURE

patient in a supine position with the hip and knee on the operated side flexed and the leg externally rotated at approximately 45 degrees. The ultrasound transducer is first positioned perpendicular to the skin approximately 8 cm distal to the inguinal crease. The location is then scanned by sliding and tilting the transducer until a clear transverse image of the hyperechoic sciatic nerve located posterior and medial to the lesser trochanter is obtained. a spinal needle 22G x 3.5 inches is advanced parallel and in line with the ultrasound transducer while the sciatic nerve is kept in the middle of the screen. The needle is advanced slowly under real-time ultrasound guidance until it is near the nerve then negative aspiration is confirmed and 20 ml of bupivacaine 0.25% is injected incrementally as the needle was withdrawn

sciatic nerve block

Eligibility Criteria

• Age: 40 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• ASA I or II physical status
• undergoing elective major knee surgery

You may not qualify if:

• refusal of the patients to give informed consent,
• preexisting coagulation disorders,
• known allergies to aminoamide local anesthetics,
• local infection at the site of the block,
• morbid obesity,
• hepatic and renal diseases
• patients with psychological disorders

Sponsors & Collaborators

• Menoufia University: lead

Study Sites (1)

Faculty of Medicine, University Hospitals

Shibīn al Kawm, Menoufia, 32511, Egypt

RECRUITING

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

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

Central Study Contacts

mostafa saieed saieed mansour, MD

CONTACT

01225484055; mostafa.said@med.menofia.edu.eg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: lecturer

Study Record Dates

• First Submitted: December 20, 2022
• First Posted: January 13, 2023
• Study Start: November 1, 2022
• Primary Completion: November 1, 2023
• Study Completion: December 1, 2023
• Last Updated: January 13, 2023

Record last verified: 2023-01

Locations

EG (1)