#Ipack blocks. trial

#Ipack blocks. trial

Ī recent randomized controlled trial concluded that, compared to mid-and distal ACB, a distal femoral triangle block (FTB) is associated with lower opioid consumption and improved postoperative analgesia for ambulatory ACL reconstruction. femoral and sciatic nerve blocks) are associated with optimal analgesia, but they can cause muscle weakness, interfering with rehabilitation and increasing the risk of falls.

Why Should I Register and Submit Results?Īn adequate balance between analgesia and motor function is an essential requirement to facilitate functional recovery and early discharge after anterior cruciate ligament (ACL) reconstruction surgery.

Oxynorm consumption in the first 24 hours post-surgeryĢ5 milliliters of ropivacaine 0.3% will be injected between popliteal artery and femur.Ģ5 milliliters of ropivacaine 0.3% will be injected on the lateral side of the femoral artery at the distal part of the femoral triangle.Ģ0 milliliters of ropivacaine 0.3% will be injected between the adductor magnus and adductor brevis muscles and between the adductor brevis muscle the pectineus.Ģ0 milliliters of ropivacaine 0.3% will be injected in supine position under the fascia iliaca lateral to the femoral artery.Ģ5 milliliters of ropivacaine 0.3% will be injected in prone position in the subgluteal space by lateral approach.ĥ milliliters of ropivacaine 0.3% will be injected laterally to the sartorius muscle. Postoperative pain: Verbal Rating Scale (VRS) Postoperative analgesia, defined by the morphine consumption in the first 48 hours post-surgery. In ward: systematic per os analgesia with paracetamol (1 g, 4 times a day) and ibuprofen (400 mg, 3 times a day) oxynorm (10 mg, lockout interval: 4 h) if VRS (pain score) >3. In post-anesthesia care unit (PACU): oxynorm titration if VRS (pain score) >3 according to the centre's usual care. Postoperative analgesia protocol : - Multimodal analgesia will be instituted from the end of the surgery by the administration of paracetamol (1 g) and ketoprofen (100 mg). Anesthesia will be maintained with propofol. In the operating room, general anesthesia will be induced by intravenous ketamine (0.4 mg/kg) and propofol (3 mg/kg). An experienced anesthetist will perform ultrasound-guided blocks 30 minutes before surgery with ropivacaine 0.3%, total volume of 70 ml. The patients will be then randomized in 2 groups: - ITO group (usual technique): IPACK combined to femoral triangle and obturator nerve blocks - Quadriblock group (experimental technique): femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks. In the pre-anaesthesia room, after the implementation of classical monitoring with an oxygen mask and a peripheral venous catheter, all patients will receive an antibioprophylaxis according to SFAR (French Society of Anesthesia & Intensive Care Medecine) recommendations and injection of 10 mg of IV dexamethasone.

The main objective of this monocenter, prospective, randomized, open-label, controlled trial is to assess the effect of quadri-block on morphine consumption after TKA compared to ITO blocks. The hypothesis of this study is that a quadruple nerve block combining femoral, sciatic, obturator and lateral femoral cutaneous nerve blocks (quadri-block) could improve analgesia after TKA. Thus, a recent study shows that the combination of IPACK, femoral triangle and obturator nerve blocks (ITO blocks) provides an effective pain control after TKA. For optimal pain management, several peripheral nerve blocks should be associated. Postoperative pain management requires multimodal analgesia, combining drugs and injection of a local anesthetic (LA).

Total knee arthroplasty (TKA) is one of the most common orthopedic surgical procedure and is associated with severe pain in the immediate postoperative period, thus limiting early recovery. Quadriblock Versus 'IPACK + Femoral Triangle Block + Obturator Nerve Block' in Total Knee Arthroplasty: a Randomized Controlled Clinical Trial