Comparison Between (GNB) Combined With (IPACK) Block Versus ACB in TKA

NCT06423339 | Completed

• 1 other identifier: FAMSU R80/2024
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

The patients will be randomized into 2 groups, named group A, B. Group A: The patients will receive Ultrasound guided Genicular nerves block combined with Ultrasound guided IPACK block. Group B: The patients will receive Adductor canal block which will be the control group. The Numerical Rating Scale (NRS) will be used to assess pain intensity. Preoperatively, all study subjects will be trained to use NRS pain scores. The spinal block will be performed. In group A, 15 mL of bupivacaine 0.25% with 2.5 g/mL adrenaline at a concentration 1:4,00,000 will be administered immediately following skin closure. GNB will be performed by using the linear ultrasound probe (10-15 MHz) Sono site M-turbo ultrasonography to scan the long bone shaft with up and down movement to recognize the epicondyle of the tibia and femur. The junctions between the epicondyle and the shafts of the femur and tibia are where the genicular arteries are located; these junctions will be defined as the periosteal areas. The superior lateral, superior medial and inferior medial genicular arteries accompany each genicular nerve. After confirmation of the genicular artery by color Doppler, the needle will be introduced using the in-plane approach and presented in the long axis view. The target point of the needle insertion will be the needle tip beside a genicular artery. Then, a 5 mL volume will be administered after gentle aspiration to prevent a faulty intra-arterial injection at 3 target locations: the superior lateral, superior medial and inferior medial genicular nerves. This will be Followed by the procedure for the IPACK block. In group B, A 22 Gauge 80 mm needle will be guided from lateral to medial to this area called the adductor canal using in-plane technique. 20 mL of 0.5% bupivacaine will be injected with peri-arterial spread after negative aspiration under sterile conditions. TKA will be performed by an orthopedic surgeon by placing three-compartment prostheses with a minimally invasive mini-midvastus approach and using hand-mixed cementing techniques.

Conditions

Post Operative Pain

Outcome Measures

Primary Outcomes (1)

• The primary outcome will be the total postoperative morphine consumption during the first two postoperative days.

  The primary outcome will be the total postoperative morphine consumption during the first two postoperative days.

  48 hours

Study Arms (2)

Group A

EXPERIMENTAL

Group A will receive genicular nerve block combined with interspace between the popliteal artery and the capsule of the posterior knee block(IPACK)

Procedure: Ultrasound guided Genicular nerve block; Procedure: Interspace between the popliteal artery and the capsule of the popliteal artery and the capsule of the posterior knee; Drug: Bupivacaine Hydrochloride

Group B

EXPERIMENTAL

Group B will receive ultrasound guided sub-sartorial Adductor canal block (ACB)

Procedure: Adductor canal block; Drug: Bupivacaine Hydrochloride

Interventions

Ultrasound guided Genicular nerve block PROCEDURE

Ultrasound guided genicular nerve block

Group A

Interspace between the popliteal artery and the capsule of the popliteal artery and the capsule of the posterior knee PROCEDURE

Ultrasound guided Interspace between the popliteal artery and the capsule of the popliteal artery and the capsule of the posterior knee

Group A

Adductor canal block PROCEDURE

Ultrasound guided sub-sartorial Adductor canal block

Group B

Bupivacaine Hydrochloride DRUG

Pupivacaine 0.5% in 20 ml vial

Also known as: Sunnypivacaine

Group A; Group B

Eligibility Criteria

• Age: 40 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients American Society of anesthesiologists' physical status (ASA) I to III.
• Aged 40 to 70 years.
• Both sexes.
• Patients scheduled for unilateral total knee replacement.

You may not qualify if:

• Patients with spinal malformation
• Patients with liver impairment
• Patients with renal impairment
• Patients younger than 40 years or older than 70 years
• Patients with hypersensitivity to one of the used drugs
• Patients with neuromuscular disorders and
• Coagulopathy disorders
• Patients scheduled for revision knee arthroplasty or those who had a past history of previous surgery or trauma to the knee

Sponsors & Collaborators

• Ain Shams University: lead

Study Sites (1)

Ain shams university hospitals

Cairo, Egypt

Location

Related Publications (1)

• Abouseeda MM, Rashed MM, Hussein MM, Nady RF, Ehab AM. A Comparative Study Between Ultrasound-Guided Genicular Nerve Block Combined With Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee Block versus Adductor Canal Block in Total Knee Replacement. Anesthesiol Res Pract. 2025 May 22;2025:8937826. doi: 10.1155/anrp/8937826. eCollection 2025.

  PMID: 40444065 DERIVED

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Bupivacaine

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer

Study Record Dates

• First Submitted: April 27, 2024
• First Posted: May 21, 2024
• Study Start: May 10, 2024
• Primary Completion: November 30, 2024
• Study Completion: November 30, 2024
• Last Updated: January 7, 2025

Record last verified: 2025-01

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)