Adductor Canal Block and IPACK Block vs Adductor Canal Block and the Gastrosoleus Interfascial Block After Total Knee Arthroplasty

NCT07336901 | Not Yet Recruiting

• 1 other identifier: R761
• Study Type: interventional
• Target: 86
• Locations: 0 countries
• Sites: N/A

Brief Summary

Evaluate analgesic efficacy of adductor canal block with IPACK versus that of adductor canal block with gastrosoleus interfascial plane block in total knee arthroplasty surgeries.

Conditions

Pain After Knee Arthroplasty

Keywords

gastrosoleus interfascial plane block, knee arthroplasty

Outcome Measures

Primary Outcomes (1)

• Postoperative pain using visual analogue score VAS score

  • Postoperative pain using vas score where 0 is worst pain, 10 is no pain

  change in VAS score 30 min after arrival to PACU change in VAS score 4 hours after arrival to PACU change in VAS score 8 hours after arrival to PACU change in VAS score 12 hours after arrival to PACU change in VAS score 24 hours after arrival to PACU

Secondary Outcomes (6)

• Time to first morphine analgesic dose and total rescue doses of morphine.

  time needed for patient to use morphine in hours after end of surgery

• cumulative doses of morphine

  cumulative doses of morphine in mg in the first 24 hours after operation

• Range of motion by assessing degree of knee extension 24 hours after surgery.

  Assessing degree of knee extension 24 hours after surgery.

• Time of first postoperative ambulation and how many feets the patient will be able to walk.

  Time of first postoperative ambulation and how many feets the patient will be able to walk in the 24 hours after operation

• Duration of postoperative hospital stay.

  Duration of postoperative hospital stay in days

Study Arms (2)

ACB/GIP group

EXPERIMENTAL

Adductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected. The gastrosoleus interfascial plane block will be given along the medial border of the leg in long axis, 7 cm-8 cm below the popliteal crease. After identification of muscle bellies of the medial gastrocnemius head, the soleus and the trilaminar fascial plane between these muscles, 20 ml of bupivacaine 0.25% will be injected at this plane by piercing the fascia.

Procedure: Adductor Canal Block (ACB) + gastrosoleus interfascial plane block

ACB/IPACK group

EXPERIMENTAL

Adductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected. The patients will receive IPACK with the patient placed in a supine position and knee placed in position of 90° flexion. By placing a low-frequency ultrasound probe in the popliteal crease the spinal needle will be advanced from medial aspect of the knee going from anteromedial to posterolateral between the popliteal artery and the femur. The tip of the needle will be placed 1-2 cm beyond the lateral edge of the artery, and 20 ml of 0.25% bupivacaine will be injected.

Procedure: Adductor Canal Block (ACB) + iPACK Block

Interventions

Adductor Canal Block (ACB) + iPACK Block PROCEDURE

Adductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected. The patients will recieve IPACK with the patient placed in a supine position and knee placed in position of 90° flexion. By placing a low-frequency ultrasound probe in the popliteal crease the spinal needle will be advanced from medial aspect of the knee going from anteromedial to posterolateral between the popliteal artery and the femur. The tip of the needle will be placed 1-2 cm beyond the lateral edge of the artery, and 20 ml of 0.25% bupivacaine will be injected.

ACB/IPACK group

Adductor Canal Block (ACB) + gastrosoleus interfascial plane block PROCEDURE

Adductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected. The patients will receive gastrosoleus interfascial plane block. Using a linear probe the transducer will be placed along the medial border of the leg in long axis, 7 cm-8 cm below the popliteal crease. After identification of muscle bellies of the medial gastrocnemius head, the soleus and the trilaminar fascial plane between these muscles, 20 ml of bupivacaine 0.25% will be injected at this plane by piercing the fascia (loss of resistance).

ACB/GIP group

Eligibility Criteria

• Age: 40 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients of ASA class I to III of both sexes
• undergoing unilateral total knee arthroplasty
• years old

You may not qualify if:

• Patient refusal
• History of coagulopathies
• Severe renal insufficiency
• Preexisting lower limb neurological abnormality
• Known allergic history to any of the drugs used in this study

Sponsors & Collaborators

• Fayoum University Hospital: lead

Related Publications (2)

• Korean Knee Society. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res. 2012 Dec;24(4):201-7. doi: 10.5792/ksrr.2012.24.4.201. Epub 2012 Nov 29.

  PMID: 23269957 BACKGROUND

• Kim DH, Pearson-Chauhan KM, McCarthy RJ, Buvanendran A. Predictive Factors for Developing Chronic Pain After Total Knee Arthroplasty. J Arthroplasty. 2018 Nov;33(11):3372-3378. doi: 10.1016/j.arth.2018.07.028. Epub 2018 Aug 4.

  PMID: 30143334 BACKGROUND

Study Officials

• Alyaa A Hassan, lecturer

  Faculty of medicine, Fayoum university

  PRINCIPAL INVESTIGATOR

• Mohamed A Shawky, Associate professor

  Faculty of medicine, Fayoum university

  STUDY DIRECTOR

• Omar S Farghaly, Associate professor

  Faculty of medicine, Fayoum university

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Alyaa A Hassan, lecturer

CONTACT

01091169956 +2; aam17@fayoum.edu.eg

Rana A Atia, lecturer

CONTACT

01002360634 +2; Raa11@fayoum.edu.eg

Study Design

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

Study Record Dates

• First Submitted: December 26, 2025
• First Posted: January 13, 2026
• Study Start: February 1, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): October 1, 2026
• Last Updated: January 13, 2026

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share