ACB With S-ESPB Versus ACB With iPACK for Knee Arthroplasty (NCT07288970) | Clinical Trial Compass
RecruitingNot Applicable
ACB With S-ESPB Versus ACB With iPACK for Knee Arthroplasty
Poland80 participantsStarted 2025-12-25
Plain-language summary
This study will compare two regional anesthesia strategies for pain management after total knee arthroplasty in adults. Both strategies use an adductor canal block (ACB) to provide analgesia while preserving quadriceps muscle strength. The ACB is then combined with either a sacral erector spinae plane block (S-ESPB) or an iPACK (infiltration between the popliteal artery and the posterior capsule of the knee) block to improve posterior knee analgesia.
All patients will receive an ultrasound-guided adductor canal block with 20 mL of 0.2% ropivacaine. They will then be randomly assigned to one of two groups:
Group 1: ACB combined with a sacral erector spinae plane block (S-ESPB) using 20 mL of 0.2% ropivacaine.
Group 2: ACB combined with an iPACK block using 20 mL of 0.2% ropivacaine. Both techniques aim to provide effective postoperative analgesia while minimizing motor blockade and allowing for early mobilization. It is not known whether combining ACB with S-ESPB or with iPACK provides superior pain control, reduces opioid requirements, or results in better functional recovery after total knee arthroplasty.
The main purpose of this study is to compare the time to first rescue analgesia and overall postoperative pain control between the two regional anesthesia strategies. The study will also evaluate opioid consumption, motor function, functional mobility, side effects, and block-related complications.
We hypothesize that both combinations will provide effective analgesia, but their impact on pain intensity, duration of analgesia, and functional recovery may differ.
Who can participate
Age range
65 Years – 100 Years
Sex
ALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion Criteria:
* Age 65 years or older
* Scheduled for elective unilateral total knee arthroplasty under spinal or general anesthesia
* ASA physical status I-III
* Planned use of regional anesthesia with an adductor canal block as part of multimodal analgesia
* Ability to communicate pain intensity using the NRS scale
* Written informed consent obtained from the patient
Exclusion Criteria:
* Refusal or inability to provide informed consent
* Allergy, intolerance, or contraindication to local anesthetics (ropivacaine)
* Pre-existing significant neurological deficit or neuropathy in the operative limb
* Coagulopathy or anticoagulation that contraindicates peripheral nerve blocks (e.g., INR \>1.5, platelets \<100,000/µL, or therapeutic anticoagulation that cannot be safely paused)
* Infection at or near the planned needle insertion sites
* Severe hepatic or renal impairment
* Chronic opioid therapy (\>30 days of daily opioid use before surgery)
* Cognitive impairment or delirium preventing reliable pain assessment BMI \> 40 kg/m² (optional - if chcesz ograniczyć ze względu na trudność USG)
* Previous knee arthroplasty on the same side or revision TKA (jeśli chcesz tylko primary TKA)
* Pregnancy or breastfeeding
* Participation in another interventional clinical trial within 30 days
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1Based on my diagnosis and history, is this trial worth exploring for me — or is there a standard treatment we should try first?
2What does this trial's phase tell us about how much is already known about its safety and benefit?
3What would taking part actually involve for me — visits, tests, time, and travel?
4What are the known and possible risks or side effects I should weigh, and how would they be monitored?
5If this trial isn't the right fit, what other options or trials would you suggest I look into?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.