IPACK Block Versus Adductor Canal Block in High Tibeal Osteotomy

Infiltration of Local Anesthetic in the Interspace Between the Popliteal Artery and Capsule of the Posterior Knee "IPACK Block" Versus Adductor Canal Block "ACB" for Pain Relief After Open Wedge High Tibial Osteotomy

Two groups of patients between 40 and 60 yrs who are undergoing open wedge high tibeal osteotomy Group 1 will receive IPACK block with 15 ml Bupivacaine, immediately before spinal anaesthesia . Group 2 will receive adductor canal block ,also with 15 ml Bupivacaine. before spinal anaesthesia. register the time of first pain sensation and firs IV analgesic dose required in each group

Two groups of people who are undergoing open wedge high tibeal osteotomy aged between 40 and 60 yrs old not diabetic and neurologically free

This group of patients will receive IPACK block immediately before spinal anaesthesia then follow up for 24 hrs to register first pain sensation and analgesic requirements

This group of patients will receive adductor canal block immediately before spinal anaesthesia then follow up for 24 hrs to register first pain sensation and analgesic requirements

Adductor canal block (ACB) is a popular peripheral nerve block that has been shown to decrease pain significantly and thereby opioid consumption with minimal effect on quadriceps function [8]. Though ACB provides analgesia to the peripatellar and intra-articular aspect of knee joint, it does not relieve posterior knee pain which is moderate to severe in intensity [9, 10]. The recent technique of an ultrasound (US)-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown to provide significant posterior knee analgesia without affecting the common peroneal nerve (CPN) [11]. We postulated that IPACK will provide better pain relief and improve knee function in the immediate postoperative period compared to ACB

If intervention which is adductor canal block or lPACK block is effective in postoperative pain control that can decrease the lV analgesic agents

Inclusion Criteria: Age 40 - 60 years. American Society of Anesthiologist class ( ASA) I - III BMI 18-35 kg/m2 Scheduled for primary unilateral open wedge high tibial osteotomy Exclusion Criteria: Known allergy to local anesthetics Contraindication to local anesthetics injection e.g. infection at the site of injection Contraindication to spinal anesthesia e.g. coagulopathy. Patients with pre-existing motor or sensory deficits in lower extremities. Insulin or noninsulin dependent diabetes mellitus. systemic corticosteroid use within 30-days of surgery difficulties in comprehending visual analog scale (VAS) pain scores history of arrhythmia or seizures severe renal insufficiency