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AnalgesiaPIPACKNCT06179641

Comparison of Two Different Regional Analgesia Techniques for Patients Undergoing Total Knee Arthroplasty

A study testing Selective tibial nerve block and IPACK block in people with Analgesia and Arthropathy of Knee, run by Centre Hospitalier Universitaire Vaudois at 1 site in Switzerland.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The objective of this clinical trial is to compare two regional analgesia techniques in patients undergoing total knee arthroplasty: IPACK (Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee) vs selective tibial nerve block. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Analgesia, Arthropathy of Knee, Postoperative Pain
What is being tested?
Selective tibial nerve block and IPACK block
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 siteSwitzerland
Study dates
8 Feb 2024to 18 Jul 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • American Society of Anesthesiologists classification I-III
  • 18 yo or older
  • patients scheduled for total knee arthroplasty under central spinal anesthesia
  • informed consent signed

Who cannot join

  • Refusal or inability for informed consent
  • Known allergies to ropivacaine, acetaminophen, ibuprofen, ketorolac, morphine, ondansetron or dexamethasone
  • Secondary surgical revision
  • Opioid treatment such as morphine, hydrocodone, hydromorphone, tramadol, methadone, fentanyl, buprenorphine or codeine
  • Bleeding diathesis
  • Neurological deficit
Show all 9Show fewer
  • Known renal insufficiency (eGFR <45 ml/min)
  • Known hepatic insufficiency (Child score B or C)
  • Alcohol abuse

Trial locations and contacts

1 site in 1 country.

Marta Szyszko du Bois d'Aische contact

+41795564002

marta.szyszko@chuv.ch

Switzerland1 site, 1 recruiting
  • University Hospital of Lausanne

    Lausanne, Canton of Vaud, 1011

    Marta Szyszko du Bois d'Aische, +41795564002, marta.szyszko@chuv.ch

    Recruiting

Other trials in Switzerland

About this study

Official title: Analgesic Efficacy of IPACK Versus Selective Tibial Nerve Block in Patients Undergoing Total Knee Arthroplasty Under Spinal Anesthesia With an Adductor Canal Block: a Randomized Controlled Double-blinded Trial

The objective of this clinical trial is to compare two regional analgesia techniques in patients undergoing total knee arthroplasty: IPACK (Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee) vs selective tibial nerve block. The main question is whether one of these peripheral blocks is more effective in reducing postoperative pain than the other. All patients will have a spinal block with an adductor canal block. One group will receive an IPACK block and the other group, a selective tibial nerve block. Postoperative pain scores and morphine consumption, among others, will be compared between groups.

Read the detailed description

The aim of this randomized controlled double blinded trail is to compare an analgesic effect of an IPACK (Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee) block vs selective tibial nerve block in patients scheduled for total knee arthroplasty under spinal anesthesia with an adductor canal block.

The investigators presume that association of a selective tibial nerve block with an adductor canal block provides better postoperative analgesia than a combination of an IPACK (Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee) block with an adductor canal block. The research team plan on including 100 patients and randomly assign them to two groups of 50 patients each. After written informed consent, patients will be allocated to one of the groups, following a computer-generated list of randomization. All patients will receive central spinal anesthesia with 12.5 mg of hyperbaric bupivacaine with 100 mcg of morphine and an adductor canal block with 150 mg of ropivacaine. IPACK block group will then receive an IPACK block with 38 mg of ropivacaine and a tibial nerve group will receive a selective tibial nerve block with 37.5 mg of ropivacaine.

During the surgery, iv dexamethasone 8 mg, iv magnesium sulfate 40 mg.kg-1, iv ketorolac 30 mg, and iv acetaminophen 1000 mg. will be administered to all patients.

After surgery, all patients will be prescribed an iv patient-controlled analgesia (PCA) of morphine (boluses of 2 mg available every 10 min, maximum of 40 mg every 4 hours) along with oral acetaminophen (1000 mg every 6 h) and oral ibuprofen (400 mg every 8 hours). Oral ondansetron 4 mg every 8 hours will be available on request in case of nausea or vomiting.

The primary outcome will be the cumulative iv morphine consumption at 24 h postoperatively. Secondary outcomes will include pain- and functional-related outcomes. Pain related outcomes are cumulative morphine consumption in the recovery room, at day 1, day 2 and day 3 postoperatively, rest and dynamic pain scores, duration of peripheral nerve block defined as the time between the execution of the block and the first dose of iv morphine, incidence of postoperative nausea and vomiting and pruritus during 3 days following surgical intervention, incidence of peroneal nerve block and complications of peripheral nerve blocks.

Being tested
Selective tibial nerve block, IPACK block
Keywords
nerve block, pain management, postoperative pain
Medical subject headings
Agnosia, Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Selective tibial nerve blockProcedure or surgery

    The selective tibial nerve block will be performed on the popliteal crease following sterilization of the area. The probe will be placed in a transverse position at the popliteal crease to visualize the popliteal artery and the tibial nerve in short axis. A 21-gauge 50mm insulated facet tip needle (SonoPlex® STIM, Pajunk, Geisingen, DE) will be inserted in-plane with the ultrasound bean from a medial to lateral direction. Once the needle tip is adjacent to the tibial nerve, 5 ml of ropivacaine 0.75% will be injected to achieve an adequate spread of local anesthetics around the nerve.

  • IPACK blockProcedure or surgery

    The IPACK (Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee) will be performed on the popliteal crease following sterilization of the area. The probe will be placed in a transverse position proximal to the popliteal crease to visualize the popliteal artery in short axis. A 21-gauge 100 mm insulated facet tip needle (SonoPlex® STIM, Pajunk, Geisingen, DE) will be inserted in-plane with the ultrasound beam, in a lateral to medial direction, between the popliteal artery and the posterior capsule, where nineteen mL of ropivacaine 0.2% will be injected under ultrasound guidance. The distribution of local anesthetics will be observed above the posterior capsule.

Study groups in NCT06179641
Study groupRoleWhat they receive
IPACK groupActive comparatorIPACK (Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee) block
Receives: Procedure: IPACK block
Tibial nerve groupExperimentalselective tibial nerve block
Receives: Procedure: Selective tibial nerve block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Total iv morphine consumption

    consumption in mg

    Measured: 24 hours postoperatively

Secondary outcomes (12)
  1. Morphine consumption in the recovery room

    consumption in mg

    Measured: From admission till discharge from the recovery room, up to 2 hours

  2. PCA administered morphine consumption

    consumption in mg administered by PCA

    Measured: at day 1, day 2 and day 3 postoperatively

  3. rest and dynamic pain scores

    Visual Analogue scale(VAS), 0-10 where 0 is no pain and 10 is the worst pain imaginable

    Measured: at day 1, day 2 and day 3 postoperatively

  4. Duration of peripheral nerve block

    Time between execution of a peripheral nerve block and the first dose of iv morphine

    Measured: From execution of a peripheral nerve block till administration of a first dose of iv morphine, up to 48 hours

  5. Incidence of postoperative nausea and vomiting

    Presence of nausea and vomiting in the postoperative period

    Measured: at day 1, day 2 and day 3 postoperatively

  6. Incidence of pruritus

    Presence of pruritus

    Measured: at day 1, day 2 and day 3 postoperatively

  7. peroneal nerve block

    presence of peroneal nerve block

    Measured: at day 1, day 2 and day 3 postoperatively

  8. complications of peripheral nerve blocks

    iv injection, hematoma, infection

    Measured: at the moment of execution of the block (day 0) and at day 3 postoperatively

  9. passive and active motion range

    joint motion in degrees

    Measured: at day 3 postoperatively

  10. quadriceps strength

    Percentage of strength as compared with the opposite leg

    Measured: at day 3 postoperatively

  11. walking distance

    walking distance without pain

    Measured: at 72h postoperatively

  12. hospital stay

    length of hospital stay in days

    Measured: from admission to the hospital till discharge, up to 3 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Dec 2023
  2. Study start8 Feb 2024
  3. Primary completion12 Jul 2025 (estimated)
  4. Study completion18 Jul 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
single centered, prospective, randomized double blinded controlled trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06179641
Sponsor's protocol ID
CER-VD 2023-02041
Acronym
PIPACK
Status last verified
Feb 2024
First submitted
30 Nov 2023
Last updated
9 Feb 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998 Jul;87(1):88-92. doi: 10.1097/00000539-199807000-00019.

    PubMed 9661552
  • Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010 Sep;92(9):1253-8. doi: 10.1302/0301-620X.92B9.24394.

    PubMed 20798443
  • Williams DP, O'Brien S, Doran E, Price AJ, Beard DJ, Murray DW, Beverland DE. Early postoperative predictors of satisfaction following total knee arthroplasty. Knee. 2013 Dec;20(6):442-6. doi: 10.1016/j.knee.2013.05.011. Epub 2013 Jun 16.

    PubMed 23777807
  • Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010 Jan;468(1):57-63. doi: 10.1007/s11999-009-1119-9.

    PubMed 19844772
  • van der Wal M, Lang SA, Yip RW. Transsartorial approach for saphenous nerve block. Can J Anaesth. 1993 Jun;40(6):542-6. doi: 10.1007/BF03009739.

    PubMed 8403121
  • Fischer HB, Simanski CJ, Sharp C, Bonnet F, Camu F, Neugebauer EA, Rawal N, Joshi GP, Schug SA, Kehlet H; PROSPECT Working Group. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia. 2008 Oct;63(10):1105-23. doi: 10.1111/j.1365-2044.2008.05565.x. Epub 2008 Jul 10.

    PubMed 18627367
  • Silverman ER, Vydyanathan A, Gritsenko K, Shaparin N, Singh N, Downie SA, Kosharskyy B. The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty. Pain Res Manag. 2017;2017:7250181. doi: 10.1155/2017/7250181. Epub 2017 Feb 2.

    PubMed 28260964
  • Paulou F, Wegrzyn J, Rossel JB, Gonvers E, Antoniadis A, Kagi M, Wolmarans MR, Lambert J, Albrecht E. Analgesic efficacy of selective tibial nerve block versus partial local infiltration analgesia for posterior pain after total knee arthroplasty: a randomized, controlled, triple-blinded trial. Anaesth Crit Care Pain Med. 2023 Aug;42(4):101223. doi: 10.1016/j.accpm.2023.101223. Epub 2023 Apr 6.

    PubMed 37030393

Questions about this trial

What is this clinical trial studying?

A study testing Selective tibial nerve block and IPACK block in people with Analgesia and Arthropathy of Knee, run by Centre Hospitalier Universitaire Vaudois at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 9 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Marta Szyszko du Bois d'Aische (+41795564002, marta.szyszko@chuv.ch), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total iv morphine consumption (time frame: 24 hours postoperatively). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06179641, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Feb 2024.

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