The aim of this study is to compare the postoperative analgesic efficacy and functional outcomes of the IPACK+Adductor Canal Block with the Genicular Nerve Block+Adductor Canal Block block in patients undergoing total knee arthroplasty (TKA). The primary objective (measurable) is to evaluate functional improvement using 6-Clicks scores, while secondary objectives include pain scores (Vas Score), opioid consumption, hospital stay duration, and patient satisfaction (Patient Satisfaction Index).
IPACK : The infiltration between the popliteal artery and capsule of the knee
Patients scheduled for spinal anesthesia with TDA.
Age ≥18.
American Society of Anesthesiologists (ASA) physical status score I-III.
Patients capable of providing informed consent.
Active infection at the injection site.
Coagulopathy or systemic sepsis.
Severe hypovolemia.
Patients who refuse regional anesthesia.
Parallel
Adductor Canal Block (ACB) + iPACK Block
DrugPatients who underwent total knee arthroplasty surgery with IPACK + adductor canal block , 25 patients. After the needle tip is placed in the target area between the popliteal artery and the femur, the local anesthetic solution (10 ml of 0.5% bupivacaine + 10 ml of physiological saline) is slowly injected after negative aspiration. After the needle tip is placed within the adductor canal, the local anesthetic solution (10 ml of 0.5% bupivacaine + 10 ml of physiological saline) is slowly injected after negative aspiration.
adductor canal block + genicular blocks
DrugPatients who underwent total knee arthroplasty surgery with genicular blocks + adductor canal block , 25 patients. The tip of the needle is directed toward the superior lateral, superior medial, and inferior medial genicular nerves under ultrasound guidance.2 ml of local anesthetic (0.5% bupivacaine) is injected into each nerve region. After the needle tip is placed into the adductor canal, the local anesthetic solution (10 ml of 0.5% bupivacaine + 10 ml of physiological saline) is slowly injected after negative aspiration.
6-Clicks score
Known as "6-Clicks" due to being composed of six scored patient activity questions, a patient's "6-Clicks" score falls on a 6- to 24-point scale where a score of 6 represents total functional impairment and a score of 24 represents total absence of impairment.
visual analog scale
The Visual Analogue Scale (VAS) is a psychometric instrument used in research and clinical studies to measure the intensity of subjective experiences that cannot be objectively quantified using defined biomarkers, such as pain, fatigue, or mood. It typically consists of a 100 mm straight line with descriptive anchors at each end representing the extremes of the sensation (for example, "no pain" at one end and "the most severe pain imaginable" at the other).
total opioid consumption
total opioid consumption per day
The Patient Satisfaction Index
The Patient Satisfaction Index (PSI) was used to describe self-evaluation of the outcome and responseof 1 or 2 was considered to indicate a satisfying outcomeand 3 or 4 to indicate a dissatisfied outcome.
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