Close this search box.

LIA vs. LIA + ACB-iPACK Block for Total Knee Arthroplasty


Study First Submitted Date 2021-03-08
Study First Posted Date 2021-03-22
Last Update Posted Date 2023-04-26
Start Month Year April 2024
Primary Completion Month Year December 2024
Verification Month Year April 2023
Verification Date 2023-04-30
Last Update Posted Date 2023-04-26

Detailed Descriptions

Sequence: 20614858
Description LIA is the mainstay of postoperative analgesia in patients having knee arthroplasty. Performed by surgeons, LIA provides effective postoperative pain relief and reduces opioid requirements. Similar analgesic benefits have also been attributed to adductor canal and iPACK blocks, which partially block sensory innervation to the knee and its posterior capsule. Performed by anesthesiologist preoperatively, these blocks have also been incorporated into the care standard in numerous centers. However, it is not clear whether adding the adductor canal and iPACK blocks yields any incremental analgesic benefits. The investigators aimed to evaluate the benefits of adding adductor canal and iPACK blocks to LIA in patients having total knee arthroplasty.


Sequence: 51898029 Sequence: 51898030
Name Nerve Block Name Neuromuscular Blockade
Downcase Name nerve block Downcase Name neuromuscular blockade

Id Information

Sequence: 39944304
Id Source org_study_id
Id Value LIA vs. LIA + ACB-iPACK block

Design Groups

Sequence: 55309091 Sequence: 55309092
Group Type Experimental Group Type Active Comparator
Title Local infiltration analgesia Title Local infiltration analgesia + ACB-iPACK block
Description Patients in this group will receive LIA intraoperatively, as per institutional standard. The injected solution will be comprised of 100cc Ropiv 2%, + Ketorolac 30 mg + Epinephrine 25 ug. Description Patients in this group will receive LIA intraoperatively, as per institutional standard. The injected solution will be comprised of 100cc Ropiv 2%, + Ketorolac 30 mg + Epinephrine 25 ug. Patients in this group will also receive preoperative nerve blocks under ultrasound guidance. These will include: Adductor canal block with 0.5% Ropivacaine w/epi 20 mL iPack block with 0.25% Ropivacaine w/epi 10 mL


Sequence: 52213928 Sequence: 52213929
Intervention Type Procedure Intervention Type Procedure
Name Local infiltration analgesia Name Ultrasound-guided adductor canal block
Description Procedure: Local infiltration analgesia performed by surgeons. Description Procedure: Ultrasound-guided adductor canal and iPACK blocks performed by anesthesiologists preoperatively.

Design Outcomes

Sequence: 176449456 Sequence: 176449457 Sequence: 176449458 Sequence: 176449459 Sequence: 176449460 Sequence: 176449461 Sequence: 176449462 Sequence: 176449463
Outcome Type primary Outcome Type primary Outcome Type secondary Outcome Type secondary Outcome Type secondary Outcome Type secondary Outcome Type secondary Outcome Type secondary
Measure Postoperative pain at rest Measure Quality of recovery (QoR-15) Measure Mean opioid analgesic consumption Measure Time to first analgesic request Measure Pain Assessment (VAS) Measure Risk of opioid-related side effects Measure Block-related complications Measure Satisfaction with pain management
Time Frame over the first 24 hours Time Frame 24 hours postoperatively Time Frame 24 hours postoperatively Time Frame Up to 48 hours following surgery Time Frame at 0, 6, 12, 18 and 24 hours Time Frame Up until one month following nerve block Time Frame Up until one month following nerve block Time Frame at 24 hours
Description Area under the curve Description Quality of Recovery (QR15) scores at 24 hours will be the second primary outcome. QR15 is a measurement of quality of recovery after surgery and anesthesia that has been psychometrically tested and validated. Reporting of outcome measures on a scale of 0 to 10 (0=None of the time and 10=All of the time). There are a total of 40 items/questions. Description Postoperative cumulative oral morphine equivalent consumption during the first 24 hours Description Visual Analogue Scale(VAS) – Pain:Overall pain assessed at rest and on movement A continuous scale comprised of a 100mm (10cm) horizontal line, anchored by 2 verbal descriptions No Pain to Worst Pain Description nausea, vomiting, pruritus, sedation Description vascular puncture, hematoma formation, intravascular injection, epidural anesthesia-bilateral sensory block Description A Patient Diary will be completed to assess overall satisfaction with analgesic technique 10 cm scale with "not satisfied at all" and "very satisfied" at either end


Sequence: 48062664
Agency Class OTHER
Lead Or Collaborator lead
Name Women's College Hospital

Overall Officials

Sequence: 29124642
Role Principal Investigator
Name Richard Brull, MD
Affiliation Women's College Hospital

Central Contacts

Sequence: 11949649
Contact Type primary
Name Didem Bozak
Phone 416-323-6008
Role Contact

Design Group Interventions

Sequence: 67805509 Sequence: 67805510 Sequence: 67805511
Design Group Id 55309091 Design Group Id 55309092 Design Group Id 55309092
Intervention Id 52213928 Intervention Id 52213928 Intervention Id 52213929


Sequence: 30603461
Gender All
Minimum Age 18 Years
Maximum Age 85 Years
Healthy Volunteers No
Criteria Inclusion Criteria: ASA classification I-III BMI < 35 kg/m2 Having elective unilateral total knee arthroplasty Exclusion Criteria: Bilateral knee surgery. Pre-existing neurological deficit or peripheral neuropathy in the lower the lower limbs Severe, poorly controlled cardiac conditions, significant arrhythmias, severe valvular heart diseases Severe, poorly controlled respiratory conditions (severe COPD, severe interstitial lung disease, severe / poorly controlled asthma) Contraindication to regional anesthesia (e.g. bleeding diathesis, coagulopathy, sepsis, infection at the site of potential needle puncture on the posterior chest) Patient refusal Chronic pain disorder Chronic opioid use (≥30 mg oxycodone / day) Contraindication (or allergy) to a component of multi-modal analgesia protocol Allergy to amide local anesthetics used in nerve blocks Contraindications to spinal anesthesia Significant psychiatric disorder that would preclude objective study assessment Pregnancy Inability to provide informed consent
Adult True
Child False
Older Adult True

Calculated Values

Sequence: 253917014
Registered In Calendar Year 2021
Were Results Reported False
Has Single Facility False
Minimum Age Num 18
Maximum Age Num 85
Minimum Age Unit Years
Maximum Age Unit Years
Number Of Primary Outcomes To Measure 2
Number Of Secondary Outcomes To Measure 6


Sequence: 30350823
Allocation Randomized
Intervention Model Parallel Assignment
Observational Model
Primary Purpose Treatment
Time Perspective
Masking Triple
Intervention Model Description Randomized, parallel group, triple blind (patient, assessor, anesthesiologist in the operating room)
Subject Masked True
Investigator Masked True
Outcomes Assessor Masked True

Intervention Other Names

Sequence: 26541283
Intervention Id 52213929
Name iPACK block

Responsible Parties

Sequence: 28724189
Responsible Party Type Sponsor

Study References

Sequence: 51787709
Pmid 30234517
Reference Type background
Citation Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, Garnett C, Ranawat AS, Su EP, Mayman DJ, Memtsoudis SG. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg. 2019 Aug;129(2):526-535. doi: 10.1213/ANE.0000000000003794.