LIA vs. LIA + ACB-iPACK Block for Total Knee Arthroplasty

Официальное название

The Ideal Analgesic Technique for Total Knee Arthroplasty: A Randomized Comparison Between Local Infiltration Analgesia Alone or Combined With Adductor Canal and iPACK Blocks

Обзор

LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. The combination of ACB-iPACK blocks has also been proposed as an effective analgesic modality for total knee arthroplasty. However, whether combining these two modalities yields any important incremental analgesic benefit remains unclear. The investigators hypothesized that the addition of ACB and iPACK blocks to LIA will yield clinically important analgesic benefits compared to LIA alone in patients having total knee arthroplasty.

Подробное описание

LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. Performed by surgeons, LIA provides effective postoperative pain relief and reduces opioid requirements. Similar analgesic benefits have also been attributed to adductor canal and iPACK blocks, which partially block sensory innervation to the knee and its posterior capsule. Performed by anesthesiologist preoperatively, these blocks have also been incorporated into the care standard in numerous centers. However, it is not clear whether adding the adductor canal and iPACK blocks yields any incremental analgesic benefits. The investigators aimed to evaluate the benefits of adding adductor canal and iPACK blocks to LIA in patients having total knee arthroplasty.

Вмешательства

• Процедура Local infiltration analgesia
  Procedure: Local infiltration analgesia performed by surgeons.
• Процедура Ultrasound-guided adductor canal block
  Procedure: Ultrasound-guided adductor canal and iPACK blocks performed by anesthesiologists preoperatively.

Первичные конечные точки

• Postoperative pain at rest [Срок оценки: over the first 24 hours]
• Quality of recovery (QoR-15) [Срок оценки: 24 hours postoperatively]

Вторичные конечные точки (6)

• Mean opioid analgesic consumption [Срок оценки: 24 hours postoperatively]
• Time to first analgesic request [Срок оценки: Up to 48 hours following surgery]
• Pain Assessment (VAS) [Срок оценки: at 0, 6, 12, 18 and 24 hours]
• Risk of opioid-related side effects [Срок оценки: Up until one month following nerve block]
• Block-related complications [Срок оценки: Up until one month following nerve block]
• Satisfaction with pain management [Срок оценки: at 24 hours]

Критерии участия

Критерии включения

• ASA classification I-III
• BMI < 35 kg/m2
• Having elective unilateral total knee arthroplasty

Критерии исключения

• Bilateral knee surgery.
• Pre-existing neurological deficit or peripheral neuropathy in the lower the lower limbs
• Severe, poorly controlled cardiac conditions, significant arrhythmias, severe valvular heart diseases
• Severe, poorly controlled respiratory conditions (severe COPD, severe interstitial lung disease, severe / poorly controlled asthma)
• Contraindication to regional anesthesia (e.g. bleeding diathesis, coagulopathy, sepsis, infection at the site of potential needle puncture on the posterior chest)
• Patient refusal
• Chronic pain disorder
• Chronic opioid use (≥30 mg oxycodone / day)
• Contraindication (or allergy) to a component of multi-modal analgesia protocol
• Allergy to amide local anesthetics used in nerve blocks
• Contraindications to spinal anesthesia
• Significant psychiatric disorder that would preclude objective study assessment
• Pregnancy
• Inability to provide informed consent

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Тройное слепое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Публикации

• Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, Garnett C, Ranawat AS, Su EP, Mayman DJ, Memtsoudis SG. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg. 2019 Aug;129(2):526-535. doi: PMID 30234517

Идентификаторы

NCT: NCT04808947 · LIA vs. LIA + ACB-iPACK block

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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