Comparing Local Anesthesia With and Without iPACK Block
Status:
Not yet recruiting
Trial end date:
2023-05-30
Target enrollment:
Participant gender:
Summary
Total knee arthroplasty is an effective surgical intervention for patients with chronic
osteoarthritis commonly performed worldwide. Postoperative pain management has been a key
focus in patient care for this procedure. Poorly controlled pain following total knee
arthroplasty is associated with decreased ambulation, increased length of hospital stay,
increased complications (particularly related to significant opioid use), and overall
suboptimal patient recovery. Appropriate postoperative pain management utilizing motor
sparing peripheral nerve blocks and periarticular injections has been shown to provide
faster, more optimized patient recovery and reduced hospital length of stay in patients
undergoing total knee arthroplasty.
Adductor canal block (ACB) is a well-studied peripheral nerve block performed for analgesia
following total knee arthroplasty. ACB is an effective component of multimodal analgesia
providing improved pain control to the peripatellar and intra-articular aspect of the knee
joint while largely preserving the strength of the quadriceps muscles1. In addition,
perioperative local infiltration analgesia (LIA) performed by the orthopaedic surgical team
is a common practice that has been shown to improve short-term postoperative pain relief and
reduce total systemic opioid consumption during hospital stay2 for total knee arthroplasty.
The Infiltration between the Popliteal Artery and Capsule of the Knee (iPACK) block is a
newly described regional anesthesia technique for postoperative analgesia in total knee
arthroplasty, performed under ultrasound guidance. It targets the articular branches of the
tibial, common peroneal, and obturator nerves in the popliteal region, and aims to provide
analgesia to the posterior aspect of the knee joint without compromising lower extremity
motor function following total knee arthroplasty.
This study aims to determine whether the IPACK block provides additional analgesia (in
combination with ACB + LIA) for total knee arthroplasty surgeries. The study will examine how
much additional analgesia IPACK provides in the context of an already-optimized regional
anesthesia pathway for total knee arthroplasty, which uses ACB + LIA, both modalities that
have reasonable existing evidence.
Phase:
Phase 4
Details
Lead Sponsor:
University of Calgary
Collaborators:
Alberta Health Services Alberta Hip and Knee Clinic