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ACB With S-ESPB Versus ACB With iPACK for Knee Arthroplasty

ConditionKnee Osteoarthritis
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age65-100
SponsorPoznan University of Medical Sciences

About this trial

This study will compare two regional anesthesia strategies for pain management after total knee arthroplasty in adults. Both strategies use an adductor canal block (ACB) to provide analgesia while preserving quadriceps muscle strength. The ACB is then combined with either a sacral erector spinae plane block (S-ESPB) or an iPACK (infiltration between the popliteal artery and the posterior capsule of the knee) block to improve posterior knee analgesia.

All patients will receive an ultrasound-guided adductor canal block with 20 mL of 0.2% ropivacaine. They will then be randomly assigned to one of two groups:

Group 1: ACB combined with a sacral erector spinae plane block (S-ESPB) using 20 mL of 0.2% ropivacaine.

Group 2: ACB combined with an iPACK block using 20 mL of 0.2% ropivacaine. Both techniques aim to provide effective postoperative analgesia while minimizing motor blockade and allowing for early mobilization. It is not known whether combining ACB with S-ESPB or with iPACK provides superior pain control, reduces opioid requirements, or results in better functional recovery after total knee arthroplasty.

The main purpose of this study is to compare the time to first rescue analgesia and overall postoperative pain control between the two regional anesthesia strategies. The study will also evaluate opioid consumption, motor function, functional mobility, side effects, and block-related complications.

We hypothesize that both combinations will provide effective analgesia, but their impact on pain intensity, duration of analgesia, and functional recovery may differ.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Age 65 years or older

Scheduled for elective unilateral total knee arthroplasty under spinal or general anesthesia

ASA physical status I-III

Planned use of regional anesthesia with an adductor canal block as part of multimodal analgesia

Disqualifiers

Refusal or inability to provide informed consent

Allergy, intolerance, or contraindication to local anesthetics (ropivacaine)

Pre-existing significant neurological deficit or neuropathy in the operative limb

Coagulopathy or anticoagulation that contraindicates peripheral nerve blocks (e.g., INR >1.5, platelets <100,000/µL, or therapeutic anticoagulation that cannot be safely paused)

Trial design

Design model

Parallel

Treatments tested in this trial

  • Adductor Canal Block

    Procedure/Surgery

    Ultrasound-guided adductor canal block performed with 20 mL of 0.2% ropivacaine injected around the saphenous nerve within the adductor canal. Used in both study arms as part of the regional anesthesia protocol for total knee arthroplasty.

  • Sacral Erector Spinae Plane Block

    Procedure/Surgery

    Ultrasound-guided sacral erector spinae plane block performed with 20 mL of 0.2% ropivacaine injected deep to the erector spinae muscle at the sacral level. Used in combination with ACB in the ACB + S-ESPB group.

  • iPACK Block

    Procedure/Surgery

    Ultrasound-guided iPACK block performed with 20 mL of 0.2% ropivacaine injected between the popliteal artery and the posterior capsule of the knee. Used in combination with ACB in the ACB + iPACK group.

Treatment groups

80 Participants
are divided into 2 treatment groups
Group A: Adductor Canal Block Plus Sacral Erector Spinae Plane Block (ACB + S-ESPB)Active comparator 2 interventions
Group B: Adductor Canal Block Plus iPACK Block (ACB + iPACK)Active comparator 2 interventions

Trial outcomes

Primary outcomes

1

Time to First Rescue Analgesia

Time (in hours) from completion of the regional blocks to the first administration of a rescue analgesic (opioid or non-opioid) given for pain intensity ≥4 on the 0-10 Numerical Rating Scale (NRS).

Time frame
Within 48 hours after surgery.

Secondary outcomes

1

Pain Intensity at Rest (NRS 0-10)

Pain at rest measured using the 0-10 NRS (0 = no pain, 10 = worst imaginable pain). Mean values will be compared between groups.

Time frame
4 hours after surgery.
2

Pain Intensity at Rest (NRS 0-10)

Pain at rest measured using the 0-10 NRS (0 = no pain, 10 = worst imaginable pain). Mean values will be compared between groups.

Time frame
8 hours after surgery.
3

Pain Intensity at Rest (NRS 0-10)

Pain at rest measured using the 0-10 NRS (0 = no pain, 10 = worst imaginable pain). Mean values will be compared between groups.

Time frame
12 hours after surgery.
4

Pain Intensity at Rest (NRS 0-10)

Pain at rest measured using the 0-10 NRS (0 = no pain, 10 = worst imaginable pain). Mean values will be compared between groups.

Time frame
24 hours after surgery.

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

Poznan University of Medical Sciences

Lead sponsor

Source ClinicalTrials.gov
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