ACB + IPACK Block for Pain Relief

Overseen By Laith Jazrawi, MD

Age: 18+

Sex: Any

Trial Phase: Phase 4

Sponsor: NYU Langone Health

Must not be taking: Opioids, Oxycodone

Disqualifiers: Chronic pain, Cognitive dysfunction, Neurologic disorder, Drug abuse, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 1

Duration: 1 week

100 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

What data supports the effectiveness of the treatment Adductor Canal Block and IPACK Block for pain relief?

Research shows that combining Adductor Canal Block (ACB) and IPACK Block can provide effective pain relief after knee surgery, especially for the back of the knee, without affecting muscle strength. This combination is as effective as other pain relief methods used after knee surgery. ^{1 2 3 4 5}

Is the combination of Adductor Canal Block and IPACK Block generally safe for pain relief in humans?

The combination of Adductor Canal Block (ACB) and IPACK Block is generally considered safe for pain relief, as studies show it provides effective pain control without affecting muscle strength or causing significant side effects. ^{1 2 3 4 6}

How is the ACB + IPACK block treatment different from other treatments for pain relief after knee surgery?

The ACB + IPACK block treatment is unique because it combines two types of nerve blocks to provide pain relief after knee surgery. The adductor canal block (ACB) targets the front of the knee, while the IPACK block focuses on the back of the knee, offering comprehensive pain control without affecting muscle strength, which helps patients move more easily after surgery. ^{1 2 3 4 6}

What is the purpose of this trial?

A randomized, single-blind, single-center study measuring the effects of adductor canal block combined with IPACK infiltration compared to adductor canal block alone on post-operative pain and opioid consumption in patients undergoing high tibial osteotomy (HTO)/distal femoral osteotomy (DFO)/tibial tubercle osteotomy (TTO).

Research Team

Laith Jazrawi, MD

Principal Investigator

NYU Langone Health

Eligibility Criteria

This trial is for patients aged 18-75 undergoing high tibial, distal femoral, or tibial tubercle osteotomy with low risk of complications (ASA I or II). Excluded are those with chronic pain and opioid use, allergies to oxycodone, additional knee procedures, extreme obesity (BMI over 45), cognitive issues, substance abuse history, severe organ disease, inability to follow instructions or pregnant women.

Inclusion Criteria

I am undergoing leg realignment surgery.

I am in good or mild systemic disease condition.

Exclusion Criteria

I have been using opioids for chronic pain for over 3 months.

Patients who are allergic to oxycodone

I am having surgery on my cartilage or ACL.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either an isolated adductor canal block or an adductor canal block combined with IPACK infiltration to manage post-operative pain

1 week

Daily visits during the first week post-operation

Follow-up

Participants are monitored for pain and opioid consumption, with assessments at various post-operative days and a 6-month follow-up

6 months

Multiple visits including POD 1, POD 2, POD 3, POD 7, and Month 6

Treatment Details

Interventions

• Adductor Canal Block
• IPACK Block

Trial Overview The study compares the effectiveness of two pain relief methods after leg bone surgery: one group receives an adductor canal block combined with IPACK infiltration while another gets only the adductor canal block. It's a randomized trial focusing on post-op pain and opioid use.

Participant Groups

Group I: Adductor Canal Block (ACB) + IPACK Block Experimental Treatment 2 Interventions

Participants receive ACB with IPACK block.

Group II: Isolated Adductor Canal Block Active Control 1 Intervention

Participants receive ACB only.

Who Is Running the Clinical Trial?

NYU Langone Health

Lead Sponsor

Trials

1,431

Recruited

838,000+

Findings from Research

In a study of 120 patients undergoing total knee arthroplasty, the combination of adductor canal block (ACB) and interspace between popliteal artery and capsule of posterior knee block (IPACK) provided significantly better pain relief compared to ACB alone, as measured by VAS scores.

Patients receiving the ACB+IPACK technique also demonstrated improved range of motion and ambulation distance post-surgery, indicating that this method enhances recovery without compromising motor function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Sankineani, SR., Reddy, ARC., Eachempati, KK., et al.[2022]

The combination of adductor canal block (ACB) with iPACK block provides noninferior pain relief compared to ACB with periarticular injection (PAI) after total knee arthroplasty, as shown in a study of 76 patients.

However, patients receiving the ACB + iPACK block required significantly more morphine and experienced greater reductions in quadriceps strength immediately after surgery, indicating potential trade-offs in functional performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adductor Canal Block Combined With iPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) Block vs Periarticular Injection for Analgesia After Total Knee Arthroplasty: A Randomized Noninferiority Trial. Kertkiatkachorn, W., Kampitak, W., Tanavalee, A., et al.[2021]

In a study of 70 patients undergoing arthroscopic knee surgeries under spinal anesthesia, those who received an adductor canal block (ACB) experienced significantly lower morphine consumption (8.63 mg) compared to those who did not receive the block (21.91 mg), indicating ACB's effectiveness in pain management.

The ACB not only prolonged the duration of analgesia (approximately 366 minutes vs. 150 minutes) but also resulted in lower pain scores during rest and knee flexion, while maintaining better hemodynamic stability and showing no complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial. Arumugam, P., Ravi, S., Ln, S., et al.[2023]

In a study of 30 patients undergoing total knee arthroplasty, both adductor canal block (ACB) and femoral nerve block (FNB) provided similar levels of pain relief, with no significant difference in morphine consumption in the first 24 hours post-surgery.

Both techniques also preserved quadriceps strength equally well, showing no significant differences in muscle strength or functional recovery at 24 and 48 hours after the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomised controlled trial comparing adductor canal block and femoral nerve block for knee arthroplasty. Lim, YC., Quek, HYK., Phoo, WHJ., et al.[2020]

References

1. France pubmed.ncbi.nlm.nih.gov

Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Adductor Canal Block Combined With iPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) Block vs Periarticular Injection for Analgesia After Total Knee Arthroplasty: A Randomized Noninferiority Trial. [2021]

4. China (Republic : 1949- ) pubmed.ncbi.nlm.nih.gov

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial. [2023]

5. India pubmed.ncbi.nlm.nih.gov

A randomised controlled trial comparing adductor canal block and femoral nerve block for knee arthroplasty. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia and Function Recovery Following Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study. [2022]