the aim of this study is to determine the analgesic effect of iPACK in combination to ACB after the excision of tumors around the Knee regarding the following:
* Time to the 1st rescue analgesia. * Postoperative morphine consumption. * Postoperative visual analogue scale (VAS). This study will include patients, aged 18 to 65 years, belonging to the American Society of Anesthesiologists (ASA) physical status II to IV , undergoing excision of tumors around the knee under spinal anesthesia.
Patients will be randomly allocated Group iPACK plus Adductor canal block (ACB) : patients will receive ACB plus iPACK block.
• Control group : patients will not receive any block but will take morphine 3mg bolus at VAS more than 4 and regular NSAIDS and paracetamol iv.
Stated willingness to comply with all study procedures and availability for the duration of the study
American Society of Anesthesiologists (ASA) physical status II-IV.
Patients undergoing excision of tumors around the knee under spinal anesthesia
Patient refusal.
Neuromuscular disorders
Allergy to local anesthetics
Previous history of knee surgery
Parallel
adductor canal block with iPACK
Procedure/SurgeryThe adductor canal will be identified. a spinal needle 22 gauge x 3.5 inches will be advanced with the guidance of ultrasound in an in-plane technique ,and 15ml of 0.5% bupivacaine will be injected then IPACK block will be performed. The probe will be applied to the popliteal fossa for identification of the popliteal artery and femur. Then, the probe will be slid distally for revealing the two femoral condyles followed by proximal sliding of the probe until the humps of the femoral condyles disappeared and the flat metaphysis appeared. a spinal needle 22G x 3.5 inches will be advanced from the lateral aspect and directed across the space between the popliteal artery and femur and once the needle reaches the medial edge of the femur, nearly at the level of the popliteal artery, negative aspiration will be confirmed and 15ml of 0.5% bupivacaine will be injected incrementally as the needle will be withdrawn
control group
Other interventionThe probe will be positioned at the midpoint between the anterior superior iliac spine and the upper pole of the patella. The adductor canal, which is a hyperechoic structure situated beneath the sartorius muscle, will be identified but no block will be done
Time to the 1st rescue analgesia
Time to the 1st rescue analgesia
Total morphine consumption
morphine consumed in 1st 24 hours postoperative in mg
pain score ( visual analogue scale)
assessment of postoperative pain using the visual analogue scale score. the scale is a straight horizontal line (100 mm). The ends are defined as the extreme limits of pain orientated from the left (no pain) to the right (worst pain).The patient marks on the line the point that they feel represents their perception of their current state. The VAS score is determined by measuring in millimetres from the left hand end of the line to the point that the patient marks.higher VAS score means worse pain
Click on the lead sponsor to view all of their trials.
