Peri-articular Injection and (IPACK) With Adductor Canal Block in Total Knee Arthroplasty.
Postoperative Pain, Regional Anesthesia
About this trial
This is an interventional supportive care trial for Postoperative Pain focused on measuring peri-articular injection, adductor canal block, IPACK, Total knee arthroplasty
Eligibility Criteria
Inclusion Criteria:
- Adult patients with severe osteoarthritis , ASA class I, II and III and scheduled for elective Total knee arthroplasty
Exclusion Criteria:
- Patient who refuse the regional anesthesia technique.
- History of allergy to local anesthetics.
- Local infection at the site of the block.
- Patients with bleeding and coagulation disorders.
- Patient with Advanced renal, hepatic and cardiac diseases.
- Preexisting lower extremity neurological abnormality, or neuropathy and difficulties in comprehending (NRS)
Sites / Locations
- Tanta university
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Adductor canal block (ACB) group
Peri-articular injection group
Adductor canal block and IPACK block group
Patients will receive ACB under ultrasound guidance in which the adductor canal was identified beneath the sartorius muscle and 20 ml of 0.25% Levobupivacaine will be injected in the canal
Patients in group II will receive intraoperative peri-articular (cocktail) injection and will be performed by a single surgeon. A periarticular cocktail injection consisting of 90 mL of normal saline, 17.5 mL of 0.5% levobupivacaine, 2 mL of ketorolac (30 mg), and 0.5mg (0.5mL) of adrenaline, The total volume of the cocktail will be 110 mL
Patients will receive ACB under ultrasound guidance in which the adductor canal was identified beneath the sartorius muscle and 20 ml of 0.25% Levobupivacaine will be injected in the canal IPACK block in which The ultrasound probe will be positioned in the popliteal crease, and needle will be inserted into the medial aspect of the knee from anteromedial to posterolateral direction in a plane between the popliteal artery and the femur and 15 ml of 0.25% Levobupivacaine will be injected