Peripheral Nerve Blocks and Postoperative Pain and Mobilization After Total Knee Arthroplasty

NCT07442123 | Completed

• 1 other identifier: 2022-11/2120
• Study Type: observational
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

Total knee arthroplasty (TKA) is frequently associated with significant postoperative pain, which may delay early mobilization and negatively affect functional recovery. Peripheral nerve blocks are widely used as part of multimodal analgesia strategies to improve postoperative pain control while minimizing opioid consumption and preserving motor function. Different peripheral nerve block techniques may result in varying analgesic efficacy and mobilization outcomes. The aim of this prospective observational study is to compare the effects of commonly used peripheral nerve block techniques on postoperative pain control and early mobilization in patients undergoing total knee arthroplasty under spinal anesthesia. Patients receiving fascia iliaca plane block are compared with those receiving a combination of adductor canal block and interspace between the popliteal artery and capsule of the knee (IPACK) block. The primary outcome is postoperative opioid consumption within the first 24 hours after surgery. Secondary outcomes include postoperative pain scores assessed at predefined time intervals, early mobilization parameters, and opioid-related adverse effects. The findings of this study are intended to contribute to optimizing analgesic strategies and improving early functional recovery following total knee arthroplasty.

Conditions

Arthropathy of Knee; Early Ambulation; Pain, Postoperative; Pain Management

Outcome Measures

Primary Outcomes (1)

• Total Postoperative Opioid Consumption

  Total opioid consumption administered via patient-controlled analgesia (PCA) during the first 24 hours following total knee arthroplasty. Opioid use is recorded as the cumulative dose of morphine (mg) delivered by the PCA device.

  Within the first 24 hours after surgery

Secondary Outcomes (2)

• Postoperative Pain Intensity (NRS Score)

  0, 2, 6, 12, and 24 hours after surgery

• Early Mobilization Performance

  24 hours after surgery

Study Arms (2)

Fascia Iliaca Plane Block

Participants in this cohort receive an ultrasound-guided fascia iliaca plane block prior to surgery as part of routine perioperative analgesia. The block is performed under sterile conditions using an in-plane technique with a high-frequency linear ultrasound probe. A total volume of 40 mL of 0.25% bupivacaine is administered within the fascia iliaca compartment. All patients undergo spinal anesthesia for total knee arthroplasty and receive standardized postoperative patient-controlled analgesia.

Procedure: Fascia Iliaca Plane Block

Adductor Canal + IPACK Block

Participants in this cohort receive a combination of ultrasound-guided adductor canal block and interspace between the popliteal artery and capsule of the knee (IPACK) block prior to surgery as part of routine perioperative analgesia. The adductor canal block is performed with 20 mL of 0.25% bupivacaine, followed by an IPACK block using 20 mL of 0.25% bupivacaine under ultrasound guidance. All patients undergo spinal anesthesia for total knee arthroplasty and receive standardized postoperative patient-controlled analgesia.

Procedure: Adductor Canal Block + IPACK Block

Interventions

Fascia Iliaca Plane Block PROCEDURE

Ultrasound-guided fascia iliaca plane block is performed under sterile conditions prior to surgery as part of perioperative analgesia. Using an in-plane technique with a high-frequency linear ultrasound probe, the needle is advanced beneath the fascia iliaca, and 40 mL of 0.25% bupivacaine is injected incrementally after negative aspiration to achieve spread within the fascia iliaca compartment.

Fascia Iliaca Plane Block

Adductor Canal Block + IPACK Block PROCEDURE

An ultrasound-guided adductor canal block followed by an interspace between the popliteal artery and capsule of the knee (IPACK) block is performed prior to surgery as part of perioperative analgesia. The adductor canal block is administered using 20 mL of 0.25% bupivacaine injected adjacent to the femoral artery beneath the sartorius muscle. Subsequently, the IPACK block is performed with 20 mL of 0.25% bupivacaine injected into the tissue plane between the popliteal artery and the posterior capsule of the knee under ultrasound guidance.

Adductor Canal + IPACK Block

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult patients undergoing elective unilateral total knee arthroplasty at a tertiary care hospital. Eligible participants include patients receiving spinal anesthesia and perioperative peripheral nerve block analgesia as part of routine clinical practice. The population represents individuals undergoing primary knee replacement surgery for degenerative joint disease who are suitable for early postoperative mobilization and standardized postoperative pain management protocols.

You may qualify if:

• Adult patients aged 18-80 years
• Scheduled for elective unilateral total knee arthroplasty
• Surgery performed under spinal anesthesia
• American Society of Anesthesiologists (ASA) physical status I-III
• Ability to understand the study procedures and provide informed consent

You may not qualify if:

• Refusal to participate
• Contraindications to spinal anesthesia or peripheral nerve block
• Known allergy to local anesthetics
• Chronic opioid use or opioid dependence
• Preexisting neurological or neuromuscular disorders affecting lower extremities
• Cognitive impairment preventing pain assessment
• Infection at the injection site
• Coagulopathy or ongoing anticoagulant therapy contraindicating regional anesthesia

Sponsors & Collaborators

• Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital: lead

Study Sites (1)

SBU Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital

Ankara, 06200, Turkey (Türkiye)

Location

Related Publications (3)

• Mou P, Wang D, Tang XM, Zeng WN, Zeng Y, Yang J, Zhou ZK. Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia and Function Recovery Following Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study. J Arthroplasty. 2022 Feb;37(2):259-266. doi: 10.1016/j.arth.2021.10.004. Epub 2021 Oct 13.

  PMID: 34653576 BACKGROUND

• Et T, Korkusuz M, Basaran B, Yarimoglu R, Toprak H, Bilge A, Kumru N, Dedeli I. Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial. J Anesth. 2022 Apr;36(2):276-286. doi: 10.1007/s00540-022-03047-6. Epub 2022 Feb 14.

  PMID: 35157136 BACKGROUND

• Kertkiatkachorn W, Kampitak W, Tanavalee A, Ngarmukos S. Adductor Canal Block Combined With iPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) Block vs Periarticular Injection for Analgesia After Total Knee Arthroplasty: A Randomized Noninferiority Trial. J Arthroplasty. 2021 Jan;36(1):122-129.e1. doi: 10.1016/j.arth.2020.06.086. Epub 2020 Jul 2.

  PMID: 32694032 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative; Agnosia

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Prof. Dr.

Study Record Dates

• First Submitted: February 24, 2026
• First Posted: March 2, 2026
• Study Start: December 1, 2022
• Primary Completion: December 1, 2024
• Study Completion: January 15, 2025
• Last Updated: March 3, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)