Evaluate analgesic efficacy of adductor canal block with IPACK versus that of adductor canal block with gastrosoleus interfascial plane block in total knee arthroplasty surgeries.
Patients of ASA class I to III of both sexes
undergoing unilateral total knee arthroplasty
40-80 years old
Patient refusal
History of coagulopathies
Severe renal insufficiency
Preexisting lower limb neurological abnormality
Parallel
Adductor Canal Block (ACB) + gastrosoleus interfascial plane block
Procedure/SurgeryAdductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected. The patients will receive gastrosoleus interfascial plane block. Using a linear probe the transducer will be placed along the medial border of the leg in long axis, 7 cm-8 cm below the popliteal crease. After identification of muscle bellies of the medial gastrocnemius head, the soleus and the trilaminar fascial plane between these muscles, 20 ml of bupivacaine 0.25% will be injected at this plane by piercing the fascia (loss of resistance).
Adductor Canal Block (ACB) + iPACK Block
Procedure/SurgeryAdductor canal block will be given. In supine position, the leg will be externally rotated and the probe will be positioned at the midpoint of the thigh on its medial aspect. The adductor canal (AC) will be located anterolaterally to the superficial femoral artery deep to the sartorius muscle. The needle (size) will be advanced and a particular "pop" will be felt when the tip pierced the vastoadductor membrane, which is the roof of the adductor canal. A single dose of (20 ml of 0.25% bupivacaine) will be injected. The patients will recieve IPACK with the patient placed in a supine position and knee placed in position of 90° flexion. By placing a low-frequency ultrasound probe in the popliteal crease the spinal needle will be advanced from medial aspect of the knee going from anteromedial to posterolateral between the popliteal artery and the femur. The tip of the needle will be placed 1-2 cm beyond the lateral edge of the artery, and 20 ml of 0.25% bupivacaine will be injected.
Postoperative pain using visual analogue score VAS score
• Postoperative pain using vas score where 0 is worst pain, 10 is no pain
Time to first morphine analgesic dose and total rescue doses of morphine.
Time to first morphine analgesic dose in hours.
cumulative doses of morphine
cumulative doses of morphine in mg
Range of motion by assessing degree of knee extension 24 hours after surgery.
Range of motion by assessing degree of knee extension 24 hours after surgery.
Time of first postoperative ambulation and how many feets the patient will be able to walk.
Time of first postoperative ambulation and how many feets the patient will be able to walk.
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