ACB and iPACK Blocks With Intravenous Dexamethasone and Perineural Dexmedetomidine in Total Knee Arthroplasty
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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: Ropivacaine 0.2% Injectable Solution, Dexamethasone, Dexmedetomidine.
- Who it may be relevant to
- Registry conditions: Knee Osteoarthritis. Basic parameters: 60 years — 100 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
- Poland
- 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 Efficacy and Safety of Three Adjuvant Strategies for ACB and iPACK Blocks in Patients Undergoing Elective Total Knee Arthroplasty: A Prospective, Randomized Clinical Trial
Overview
This prospective randomized controlled trial aims to compare the analgesic efficacy and safety of three adjuvant strategies for ultrasound-guided Adductor Canal Block (ACB) and iPACK block in patients undergoing elective total knee arthroplasty under spinal anesthesia. All participants will receive standardized spinal anesthesia with 0.5% ropivacaine combined with ACB and iPACK blocks using 0.2% ropivacaine. Patients will be randomized into one of three groups: standard ACB + iPACK without adjuvants, ACB + iPACK with intravenous dexamethasone 8 mg, or ACB + iPACK with intravenous dexamethasone 8 mg combined with perineural dexmedetomidine added to both regional blocks. The primary outcome will be total postoperative opioid consumption during the first 48 hours after surgery expressed as intravenous morphine equivalents. Secondary outcomes will include pain intensity at rest and during movement, duration of analgesia, time to first rescue analgesia, quadriceps muscle strength, early mobilization, adverse events, inflammatory markers, and length of hospital stay.
Detailed description
Postoperative pain following total knee arthroplasty (TKA) remains a major clinical challenge and may negatively affect early mobilization, rehabilitation, patient satisfaction, and postoperative recovery. Inadequate pain control after TKA is associated with increased opioid consumption and opioid-related adverse events, including nausea, vomiting, sedation, urinary retention, respiratory depression, and postoperative delirium, particularly in elderly patients.
Ultrasound-guided Adductor Canal Block (ACB) combined with iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block has become an increasingly popular regional anesthesia strategy for TKA because it may provide effective analgesia while preserving quadriceps muscle strength and facilitating early mobilization. The ACB primarily targets the sensory innervation of the anterior and medial aspects of the knee, whereas the iPACK block supplements analgesia of the posterior knee capsule.
Several adjuvant medications have been investigated to prolong the duration and improve the quality of peripheral nerve blocks. Intravenous dexamethasone is widely used as a perioperative analgesic adjunct and may prolong postoperative analgesia while also reducing postoperative nausea and vomiting. Perineural dexmedetomidine has been shown to prolong sensory blockade, improve analgesia quality, and reduce opioid requirements. However, the optimal combination of systemic and perineural adjuvants for ACB and iPACK blocks in TKA remains unclear.
The aim of this prospective randomized controlled trial is to compare three perioperative analgesic strategies in patients undergoing elective primary unilateral total knee arthroplasty under spinal anesthesia:
Standard ACB + iPACK without adjuvants, ACB + iPACK with intravenous dexamethasone 8 mg, ACB + iPACK with intravenous dexamethasone 8 mg combined with perineural dexmedetomidine.
All participants will receive standardized spinal anesthesia with 0.5% ropivacaine (3-4 mL). Ultrasound-guided ACB and iPACK blocks will be performed using 20 mL of 0.2% ropivacaine for each block. In the dexmedetomidine group, 12.5 µg of dexmedetomidine will be added to each regional block.
The primary endpoint of the study will be total postoperative opioid consumption during the first 48 postoperative hours expressed as intravenous morphine equivalents. Secondary endpoints will include postoperative pain scores at rest and during movement, time to first rescue analgesia, duration of analgesia, quadriceps muscle strength, early mobilization, opioid-related adverse events, dexmedetomidine-related adverse events such as bradycardia and hypotension, inflammatory markers, and length of hospital stay.
The study hypothesis is that intravenous dexamethasone will improve postoperative analgesia compared with standard ACB + iPACK alone, while the addition of low-dose perineural dexmedetomidine will further prolong analgesia duration and reduce opioid consumption without significantly increasing adverse events or impairing postoperative mobilization.
Interventions
- Drug Ropivacaine 0.2% Injectable Solution
Ropivacaine 0.2% used for ultrasound-guided ACB and iPACK blocks (20 mL per block). - Drug Dexamethasone
Intravenous dexamethasone 8 mg administered perioperatively. - Drug Dexmedetomidine
Perineural dexmedetomidine 12.5 μg added to each regional block (ACB and iPACK).
Primary outcome measures
- Total postoperative opioid consumption during the first 48 hours after surgery [Time frame: 48 hours after surgery]
Secondary outcome measures (12)
- Pain intensity at rest [Time frame: 6 hours after surgery]
- Pain intensity at rest [Time frame: 12 hours after surgery]
- Pain intensity at rest [Time frame: 24 hours after surgery]
- Pain intensity at rest [Time frame: 48 hours after surgery]
- Pain intensity during movement assessed using the Numeric Rating Scale [Time frame: 6 hours postoperatively]
- Pain intensity during movement assessed using the Numeric Rating Scale [Time frame: 12 hours postoperatively]
- Pain intensity during movement assessed using the Numeric Rating Scale [Time frame: 24 hours postoperatively]
- Pain intensity during movement assessed using the Numeric Rating Scale [Time frame: 48 hours postoperatively]
- Time to first rescue analgesia [Time frame: 48 hours after surgery]
- Quadriceps muscle strength of the operated limb [Time frame: 6 hours postoperatively]
- Quadriceps muscle strength of the operated limb [Time frame: 12 hours postoperatively]
- Quadriceps muscle strength of the operated limb [Time frame: 24 hours postoperatively]
Eligibility criteria
Inclusion criteria
- Age between 60 and 100 years
- Scheduled for elective primary unilateral total knee arthroplasty
- American Society of Anesthesiologists (ASA) physical status I-III
- Ability to understand study procedures and provide written informed consent
- Eligibility for spinal anesthesia and ultrasound-guided regional anesthesia according to institutional standards
Exclusion criteria
- Known allergy or hypersensitivity to ropivacaine, dexamethasone, dexmedetomidine, or any study-related medication
- Contraindications to spinal anesthesia or peripheral nerve blocks
- Coagulation disorders or anticoagulant therapy preventing safe regional anesthesia
- Infection at the planned puncture site or systemic infection
- Severe neurological disorders affecting lower limb sensory or motor function
- Severe hepatic, renal, or uncontrolled cardiovascular disease
- Clinically significant bradycardia or advanced atrioventricular conduction abnormalities
- Chronic opioid use for more than 3 months before surgery
- Uncontrolled diabetes mellitus or contraindications to dexamethasone administration
- Inability or refusal to provide written informed consent
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
- Quadruple blind
- Primary purpose
- Treatment
Study locations
Poland · 2 centers
- The John Paul II Catholic University of Lublin — Lublin
- Poznan University of Medical Sciences — Poznan
Identifiers
NCT: NCT07677215 · 6/2026