Two nerve-block approaches to control pain after knee replacement

Comparison of Adductor Canal Block Combined With Sacral Erector Spinae Plane Block Versus Adductor Canal Block Combined With iPACK Block in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Tria

This will test whether adding either a sacral erector spinae plane block (S-ESPB) or an iPACK block to an adductor canal block provides better pain relief after total knee replacement in adults aged 65 and older.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 80 (estimated)
• Ages: 65 Years to 100 Years
• Sex: All
• Sponsor: Poznan University of Medical Sciences (other)
• Locations: 1 site (Poznan)
• Trial ID: NCT07288970 on ClinicalTrials.gov

What this trial studies

Total knee arthroplasty causes significant postoperative pain that can limit early mobilization and increase opioid use. In this randomized comparison, all participants receive an ultrasound-guided adductor canal block (ACB) with 20 mL of 0.2% ropivacaine and are then assigned to receive either a sacral erector spinae plane block (S-ESPB) or an iPACK block using 20 mL of 0.2% ropivacaine. The trial compares postoperative pain control, extent of motor-sparing (quadriceps strength), and early mobility between the two combinations. Procedures and outcomes are measured in adults undergoing elective unilateral total knee arthroplasty at a single center.

Who should consider this trial

Good fit: Ideal candidates are adults aged 65 or older scheduled for elective unilateral total knee arthroplasty with ASA physical status I–III who can provide informed consent and report pain using the NRS scale.

Not a fit: Patients with contraindications to peripheral nerve blocks or local anesthetics (for example severe coagulopathy, active infection at block sites, significant neuropathy, severe hepatic/renal impairment, or chronic daily opioid use) are unlikely to benefit from participation.

Why it matters

Potential benefit: If successful, the approach could improve pain control after knee replacement while preserving quadriceps strength to support earlier mobilization and lower opioid needs.

How similar studies have performed: Combining an adductor canal block with iPACK has shown promising results in prior work for posterior knee analgesia, while sacral ESPB is a newer, less extensively studied fascial-plane approach with limited but growing supportive data.

Eligibility criteria

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

Where this trial is running

Poznan

• Poznan University of Medical Sciences — Poznan, Poland (RECRUITING)

Study contacts

• Study coordinator: Malgorzata Reysner, MD PhD

Conditions: Knee Osteoarthritis