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NCT Number: NCT07130552

Comparison of Distal IPACK and Popliteal Plexus Block Combined With Femoral Triangle Block After Total Knee Arthroplasty

This study aims to investigate the effect of femoral triangle block combined with popliteal plexus block and distal IPACK block on postoperative pain after total knee arthroplasty (TKA)

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Key information

Conditions

Osteo Arthritis of the Knee

Age range

18 year–85 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Karaman Training and Research Hospital, Karaman, Karaman 70200

Karaman, 70200, Turkey (Türkiye)

Location status: Recruiting

Location contact

Tayfun Et

CONTACT

[email protected]

05063670717

About this study

Popliteal Plexus Block (PPB) is a new nerve block technique that has been shown to anaesthetise nerves involved in the innervation of the posterior part of the knee joint.

The IPACK (interspace between the popliteal artery and capsule of the posterior knee) block is a regional anesthesia technique in which a local anesthetic is infiltrated under ultrasound guidance between the popliteal artery and the capsule of the posterior knee. This technique blocks the branches of the obturator nerve, the common peroneal nerve, and the tibial nerve in the popliteal region. In the context of knee arthroplasty, the application of the IPACK block has been associated with lower scores for ambulatory pain, lower scores for resting pain, and reduced morphine consumption.

Although both techniques of blockade seem to be efficient in the context of analgesia for the posterior part of the knee after TKA. No study compares these two blocks as part of multimodal analgesia to provide pain relief after TKA.

This study aimed to evaluate the analgesic effect of PPB or distal IPACK, in addition to femoral triangle block, as a component of a multimodal analgesic regimen after TKA.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients undergoing total knee arthroplasty under spinal anesthesia
  • American Society of Anesthesiologists (ASA) status I-III
  • Patients who give informed consent

Exclusion criteria

  • Patients unable to cooperate
  • Kidney disease with GFR < 50 ml/min
  • Daily opioid consumption > 1 month
  • Allergy to local anesthetics
  • Neurological problems of the lower extremity
  • Contraindications to peripheral nerve blocks

Treatment and study plan

femoral triangle block and popliteal plexus block

Device

Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for PPB

Femoral triangle block and distal iPACK

Device

Single dose bolus, 10 ml 5% bupivacaine will be used for FTB, 10 ml 5% bupivacaine will be used for distal iPACK

Primary outcomes

  1. Opioid consumption

    Time frame: 24 hours

    Total opioid consumption in each group, A, B until 24 hours postoperative.

Secondary outcomes

  1. NRS scores

    Time frame: 48 hours

    Numerical Rating Scale (NRS) scores (Range 0-10, 0=no pain, 10=the worse pain ever)

  2. Range of knee motion

    Time frame: 48 hours

    Degrees of flexion

  3. Patient mobilization

    Time frame: 48 hours

    Patient reporting time of first standing to the side of the bed and time up and go test 2 days

  4. Post-block Maximum Voluntary Isometric Contraction (MVIC) by knee extension, calculated as a percentage of the Pre-block baseline value

    Time frame: A 60-minute interval is between pre-block and post-block MVIC assessments

    Both MVIC test are assessed preoperative, using a handheld dynamometer

  5. Post-block MVIC by ankle plantarflexion, calculated as a percentage of the Pre-block baseline value

    Time frame: A 60-minute interval is between pre-block and post-block MVIC assessments

    Both MVIC tests are assessed preoperative, using a handheld dynamometer

  6. Post-block MVIC by ankle dorsiflexion, calculated as a percentage of the Pre-block baseline value

    Time frame: A 60 minutes interval is between pre-block and post-block MVIC assessments

    Both MVIC tests are assessed preoperative, using a handheld dynamometer

  7. Muscle strength of knee extension, graded by Manual Muscle Test (MMT)

    Time frame: Assessed pre-block, post-block (60 minutes after pre-block), and postoperative 5 hours

    Grade 3: Able to extend the knee in active Range of Motion (ROM) against gravity, Grade 2: Patient is lying on the side, with knee resting on the bed, able to extend the knee in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the quadriceps muscle is palpable or observable but the knee does not extend, Grade 0: No muscle contraction of the quadriceps muscle is palpable or observable

  8. Muscle strength of ankle plantarflexion, graded by MMT

    Time frame: Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours

    Grade 3: Able to plantarflex in active ROM, Grade 2: Patient is lying on the side, with ankle resting on the bed, able to plantarflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the gastrocnemius muscle is palpable or observable but the ankle does not plantarflex, Grade 0: No muscle contraction of the gastrocnemius muscle is palpable or observable

  9. Muscle strength of ankle dorsiflexion, graded by MMT

    Time frame: Assessed pre-block, post-block (60 minutes after pre-block) and postoperative 5 hours

    Grade 3: Able to dorsiflex in active ROM Grade 2: Patient is lying on the side, with ankle resting on the bed, able to dorsiflex the ankle in active ROM with minimal assistance from the investigator, Grade 1: Muscle contraction of the tibialis anterior muscle is palpable or observable but the ankle does not dorsiflex, Grade 0: No muscle contraction of the tibialis anterior muscle is palpable or observable

  10. Incidence of rebound pain

    Time frame: Postoperative 24 hours

    Rebound pain is described as severe pain (NRS ≥ 7)

  11. Quality of Recovery 15 Score

    Time frame: Postoperative Day 1

    Quality of Recovery (QoR)-15 survey.Minimum value: 0, Maximum value: 150, higher scores mean better.

Study contacts

Contact information is provided by the study sponsor or research team.

Tayfun Et

CONTACT

[email protected]

+905063670717

Sponsors and collaborators

Lead sponsor

Karaman Training and Research Hospital

Other

Registry information

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Aug 19, 2025
Registry last updated
Apr 28, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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