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A Randomized Comparison of the Efficacy of the IPACK Block Versus the Popliteal Plexus Block for Posterior Knee Analgesia, in Patients Undergoing a Total Knee Arthroplasty and Receiving a Continuous Distal Femoral Triangle Block
Sponsor: Clinica Santa Maria
Summary
Total knee arthroplasty (TKA) is commonly associated with significant postoperative pain, including pain arising from the posterior aspect of the knee. Regional anesthesia techniques are frequently used as part of a multimodal analgesic strategy to improve pain control, reduce opioid requirements, and facilitate early functional recovery. This prospective, randomized, double-blind, superiority clinical trial will compare the analgesic efficacy of the interspace between the popliteal artery and capsule of the posterior knee (iPACK) block with the popliteal plexus block in adult patients undergoing elective unilateral primary total knee arthroplasty. All participants will receive a continuous femoral triangle block and a standardized multimodal postoperative analgesic regimen. Participants will be randomly assigned to receive either an ultrasound-guided iPACK block or an ultrasound-guided popliteal plexus block. The primary outcome will be cumulative intravenous morphine consumption delivered through a patient-controlled analgesia (PCA) device during the first 24 hours after surgery. Secondary outcomes will include cumulative morphine consumption during the first 12 hours, posterior knee pain at rest and during movement, time to first PCA morphine administration, quality of recovery assessed with the QoR-15 questionnaire, distal motor function, early functional recovery, block performance time, postoperative adverse effects, and neurological symptoms. The study hypothesis is that the popliteal plexus block will provide superior opioid-sparing analgesia compared with the iPACK block when both techniques are combined with a continuous femoral triangle block, while preserving distal motor function and maintaining an acceptable safety profile.
Official title: iPACK Block Versus Popliteal Plexus Block for Posterior Analgesia After Primary Total Knee Arthroplasty in Patients Receiving a Continuous Femoral Triangle Block: A Double-Blind Randomized Clinical Trial
Key Details
Gender
All
Age Range
18 Years - 85 Years
Study Type
INTERVENTIONAL
Enrollment
136
Start Date
2026-11-01
Completion Date
2028-05-30
Last Updated
2026-10-15
Healthy Volunteers
No
Conditions
Interventions
Ultrasound-Guided iPACK Block
An ultrasound-guided iPACK block will be performed by depositing 20 mL of 0.25% bupivacaine in the tissue plane between the popliteal artery and the posterior capsule of the knee to provide analgesia to the posterior aspect of the knee while minimizing blockade of the major motor branches of the sciatic nerve
Ultrasound-Guided Popliteal Plexus Block
An ultrasound-guided popliteal plexus block will be performed using 20 mL of 0.25% bupivacaine. The technique is intended to provide analgesia to the posterior aspect of the knee by targeting the neural plexus contributing to the sensory innervation of the posterior knee while minimizing clinically relevant distal motor blockade
Ultrasound-Guided Continuous Femoral Triangle Block
All participants will receive an ultrasound-guided continuous femoral triangle block. An initial bolus of 20 mL of 0.25% bupivacaine will be administered, followed by a continuous infusion of 0.1% bupivacaine at 5 mL/hour through a perineural catheter as part of the standardized postoperative analgesic regimen