Genicular vs IPACK Block for Analgesia in Knee Arthroplasty
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: IPACK block, Genicular nerve block with bupivacaine.
- Who it may be relevant to
- Registry conditions: Postoperative Pain Management in Total Knee Arthroplasty. Basic parameters: 18 years — 70 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Center list to be confirmed — check the primary protocol.
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Comparison of the Postoperative Analgesic Efficacy of Genicular Block and IPACK Block in Addition to Adductor Canal Block in Knee Arthroplasty
Overview
Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures, and with the aging population, the global number of TKA cases is expected to increase sixfold within the next decade. Postoperative pain following TKA is often severe and difficult to manage, which may increase the risk of developing chronic pain. Effective pain control is therefore a major concern, and multimodal analgesia is recommended to enhance analgesia, reduce opioid consumption, and minimize opioid-related side effects. Peripheral nerve blocks (PNBs) are an integral part of multimodal regimens. Among them, the adductor canal block (ACB), which provides analgesia to the anteromedial aspect of the knee while preserving motor function, is widely used. The optimal analgesic strategy for TKA should not only ensure adequate pain relief but also maintain quadriceps strength to allow early mobilization. Motor-sparing blocks combined with multimodal analgesia have become increasingly popular because they facilitate early rehabilitation, decrease opioid requirements, and improve recovery outcomes. The knee joint has a complex innervation, receiving contributions from the femoral, sciatic, and obturator nerves. For this reason, combining different PNBs may provide superior analgesia compared to a single block (2). The genicular nerves, consisting of branches from the femoral, common peroneal, saphenous, tibial, and obturator nerves, innervate the knee capsule. Genicular nerve block specifically targets these branches and has been used to manage postoperative pain in TKA patients. Another motor-sparing option is the interspace between the popliteal artery and posterior capsule of the knee (IPACK) block, which provides analgesia to the posterior aspect of the knee. Using ultrasound guidance, local anesthetic is deposited between the posterior capsule and the popliteal artery. This approach spares the main trunks of the tibial and common peroneal nerves while effectively blocking the terminal branches innervating the posterior capsule, including the genicular nerves and the popliteal plexus. However, there are no studies in the literature directly comparing IPACK and genicular blocks. With this study, the investigators aim to compare the efficacy of these two blocks in patients undergoing TKA.
Interventions
- Procedure IPACK block
After the general anesthesia induction, IPACK block will be performed with 0.25% bupivacaine (20 mL) using ultrasound in addition to adductor canal block. - Procedure Genicular nerve block with bupivacaine
After the general anesthesia induction, genicular block will be performed with 0.25% bupivacaine (20 mL) using ultrasound in addition to adductor canal block.
Primary outcome measures
- Morphine consumption [Time frame: Postoperative day 1 (24th hour)]
Secondary outcome measures (4)
- NRS Scores [Time frame: Postoperative day 1 (1st, 6th, 12th and 24th hour)]
- QoR-15 [Time frame: Postoperative 12th day]
- Nausea-vomiting [Time frame: Postoperative day 1]
- Rescue analgesic [Time frame: Postoperative day 1]
Eligibility criteria
Inclusion criteria
- Patients undergoing unilateral total knee arthroplasty
- ASA physical status I-III
Exclusion criteria
- BMI > 35
- Patients < 50 kg
- Allergy to study medications
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Triple blind
- Primary purpose
- Treatment
Study locations
Center list to be confirmed — check the primary protocol.
Identifiers
NCT: NCT07171931 · KAD-FR-42