![]() Late functional-related outcomes include range of motion, strength, hop distance, agility test, Y balance test, Anterior Cruciate Ligament Return to Sport After Injury Scale (ACL-RSI) and International Knee Documentation Committee Scale (IKDC) at 4 and 8 months postoperatively. Early functional-related outcomes include range of motion, strength and walking distance at 24 h and 48 h postoperatively. Pain-related outcomes include cumulative morphine consumption at 2h and 48h postoperatively, rest and dynamic pain scores and rate of PONV at 2 h, 24 h and 48 h postoperatively. Secondary outcomes will include pain- and functional-related outcomes. The primary outcome will be the cumulative iv morphine consumption at 24 h postoperatively. Oral ondansetron 4 mg every 8 hours will be available on request in case of nausea or vomiting. In both groups, patients will have the surgery under general anaesthesia with a multimodal analgesic regimen inclusive of iv dexamethasone 8 mg, iv magnesium sulfate 40 mg.kg-1, iv ketorolac 30 mg, and iv acetaminophen 1000 mg.Īfter surgery, all patients will be prescribed an iv patient-controlled analgesia (PCA) of morphine (boluses of 2 mg available every 10 min, maximum of 40 mg every 4 hours) along with oral acetaminophen (1000 mg every 6 h) and oral ibuprofen (400 mg every 8 hours). In group IPACK the patient will receive in addition an IPACK with 20ml of ropivacaine 0.2%. In group TIBIAL the patient will receive in addition a selective tibial nerve block with 5 ml of ropivacaine 0.75%. Prior to surgery, all patients will have an adductor canal block with 20ml of ropivacaine 0.75%. After written informed consent, patients will be allocated to one of the groups, following a computer-generated list of randomization. ![]() This randomized controlled trial will include two groups: an adductor canal block plus IPACK group (group IPACK) and an adductor canal block plus tibial selective nerve block group (group TIBIAL). The hypothesis of this study is that a combined adductor canal and selective tibial nerve block provides better analgesia than a combined adductor canal block and IPACK in patients undergoing anterior cruciate ligament reconstruction. Why Should I Register and Submit Results?. ![]() BMI 45 - Opioid consumption of greater or equal to 30mg morphine equivalents per day - Age 80 years old - ASA IV or greater - Inability to use a PCA - Inability to access the intrathecal space - Infection at the site of injection (either for spinal or PNB) - INR greater than or equal to 1.4Ĭontact information is only displayed when the study is recruiting subjects.Ĭontrol arm to receive Adductor Canal Block without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidanceĮxperimental arm to receive Adductor Canal Block plus SPANK Block (Sensory Posterior Articular Nerves of the Knee) without additional interventions Intervention: ropivacaine 0.5% 15cc injected under ultrasound guidance into the adductor canal plus 20cc ropivacaine 0. Inclusion Criteria: - Patients between the ages of 40 and 80 years old undergoing total knee arthroplasty amenable to peripheral nerve block for perioperative analgesia. The drug itself is not being studied and the same concentration will be used in all participants.Įchogenic needle used for ultrasound guided nerve blockade. Injection of local anesthetic into the inner thigh under ultrasound guidance to provide sensory blockade to the anterior aspect of the kneeĪmide local anesthetic, this concentration is commonly used to achieve surgical level anesthesia. Injection of local anesthetic into the tissues on the posterior aspect of the knee to provide sensory blockade of the articular nerves of the knee. ![]() SPANK Block (Sensory Posterior Articular Nerves of the Knee) The study will aid in answering the question of whether SPANK block is an effective adjunct in preventing pain and decreasing opioid requirement after TKA. Secondary outcomes include pain scores recorded at 4, 8, 12, 16, 20, and 24 hours post-operatively, cumulative pain score, incidence of post-operative nausea and vomiting, and extent of motor blockade. ![]() The primary outcome is pain control, which will be measured throughout the post-operative course using morphine equivalents of opioid analgesics used during the first 24 hours after surgery. It is important to be specific in your procedure note as. What is the CPT code for nerve block These codes are dependent on the anatomical location of the nerve being blocked (CPT codes 64400-64530). Therefore, code 64999, Unlisted procedure, nervous system, should be reported. This is a prospective, randomized control trial to compare SPANK block combined with adductor canal block to adductor canal block alone in treatment of post-operative pain after total knee arthroplasty. Currently, there is no specific CPT code to report an IPACK block. San Antonio Uniformed Services Health Education Consortium Single Dose Adductor Canal Block With SPANK (Sensory Posterior Articular Nerves of the Knee) Block Compared to Single Dose Adductor Canal Block and Pain Control After Total Knee Arthroplasty ![]()
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