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iPACK Block vs. Periarticular Infiltration for TKA Pain Control
Sponsor: Turgutlu State Hospital
Summary
This study aims to compare two different multimodal analgesic techniques for pain management after total knee arthroplasty (TKA). The primary purpose is to determine if a combination of two specific nerve blocks administered by an anesthesiologist (Femoral Triangle Block + iPACK block) results in superior pain control compared to a combination of a nerve block and a local infiltration administered by the surgeon (FTB + Periarticular Infiltration \[PAI\]). The hypothesis is that the FTB + iPACK combination will lead to a significant reduction in Numeric Rating Scale (NRS) pain scores with movement at 24 hours postoperatively. This will be a prospective, randomized, double-blind, parallel-group, single-center study involving patients scheduled for primary unilateral TKA. Participants will be randomly assigned to one of two groups. All patients, clinicians (anesthesiologists and surgeon), and outcome assessors will be blinded to the group allocation using a double-dummy technique.
Official title: Analgesic Efficacy of iPACK Block Versus Periarticular Infiltration as an Adjunct to Femoral Triangle Block in Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind, Controlled Trial
Key Details
Gender
All
Age Range
18 Years - 80 Years
Study Type
INTERVENTIONAL
Enrollment
100
Start Date
2026-01-01
Completion Date
2026-08-01
Last Updated
2025-12-05
Healthy Volunteers
No
Interventions
FTB
All patients will receive an ultrasound-guided Femoral Triangle Block (FTB) with 20 mL of 0.25% Bupivacaine, supplemented by an Anterior Femoral Cutaneous Nerve block with 5 mL of the same solution.
IPACK block
Patients will receive an ultrasound-guided real iPACK block with 20 mL of 0.25% Bupivacaine
Sham Intervention 1 (Surgeon)
Patients will receive a sham Periarticular Infiltration (PAI) with an equivalent volume of normal saline intraoperatively.
Sham Intervention 2 (Anesthesiologist)
Patients will receive a sham iPACK block with an equivalent volume of normal saline preoperatively.
PAI (Surgeon)
The surgeon intraoperatively administers the standardized PAI cocktail (total volume approx. 50 mL): 24 mL 0.5% Bupivacaine, 0.3 mL Adrenaline (1:1000), 40 mg Methylprednisolone, 1 gr Cefazoline, and 22 mL 0.9% Sodium Chloride. The surgeon will administer the infiltration into the medial, lateral, and posterior quadrants of the knee capsule, specifically sparing the anterior quadrant.
Bupivacaine %0.25 (isobaric)
Used for FTB and iPACK blocks.
Bupivacaine + Adrenaline + Methylprednisolone + Cefazoline
Used for PAI
Normal Saline (0.9% NaCl)
Used for sham/placebo infiltration or block.