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Anterior Cruciate Ligament RuptureNCT05068063

Femoral Triangle + IPACK Blocks for ACL Reconstruction Analgesia

A study testing Bupivacaine Injection and normal Saline in people with Anterior Cruciate Ligament Rupture and Acute Pain, run by University of Chile at 2 sites in Chile.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

An adequate balance between analgesia and motor function is an essential requirement to facilitate functional recovery and early discharge after anterior cruciate ligament (ACL) reconstruction surgery. Proximal nerve blocks (i.e. Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Bupivacaine Injection and normal Saline
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
2 sitesChile
Study dates
1 Jun 2022to 15 Oct 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient scheduled to undergo anterior cruciate ligament reconstruction under general anesthesia with ipsilateral autologous graft.
  • Age between 18 and 65 years
  • American Society of Anesthesiologists classification 1-3
  • Body mass index between 19 and 35 (kg/m2)

Who cannot join

  • Adults who are unable to give their own consent
  • Pre-existing neuropathy (assessed by history and physical examination)
  • Coagulopathy (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. platelets ≤ 100, International Normalized Ratio ≥ 1.4 or prothrombin time ≥ 50)
  • Renal failure (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. creatinine ≥ 100)
  • Hepatic failure (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. transaminases ≥ 100)
  • Allergy to local anesthetics (LAs), morphine or tramadol
Show all 10Show fewer
  • Pregnancy
  • ACL revision surgery
  • Contralateral graft or any type of allograft
  • Chronic pain syndromes requiring opioid intake at home

Trial locations and contacts

2 sites in 1 country.

Sebastian L Layera, MD contact

+562 29788221

sebastianlayera@gmail.com

Julian Aliste, MD contact

+562 29788221

julian.aliste@uchile.cl

Chile2 sites, 1 recruiting
  • Clinica Alemana de Santiago

    Santiago, RM

    Active, not recruiting
  • Hospital Clinico Universidad de Chile

    Santiago, RM

    Sebastian L Layera, MD, +562 29788221, sebastianlayera@gmail.com

    Recruiting

Other trials in Chile

About this study

Official title: A Randomised Comparison Between Combined Femoral Triangle Block+IPACK Block and Femoral Triangle Block for Anterior Cruciate Ligament Reconstruction Analgesia

An adequate balance between analgesia and motor function is an essential requirement to facilitate functional recovery and early discharge after anterior cruciate ligament (ACL) reconstruction surgery.

Proximal nerve blocks (i.e. femoral and sciatic nerve blocks) are associated with optimal analgesia, but they can cause muscle weakness, interfering with rehabilitation and increasing the risk of falls .

Read more

A recent randomized controlled trial concluded that, compared to mid-and distal ACB, a distal femoral triangle block (FTB) is associated with lower opioid consumption and improved postoperative analgesia for ambulatory ACL reconstruction.

In ACL reconstruction surgery there are other potential sources of pain not covered by a FTB, such as intra-articular structures (menisci, cruciate ligaments), posterior knee capsule and the graft donor site.

Evidence supporting the addition of an IPACK block to a FTB has been studied for patients undergoing total knee replacement, nonetheless, there is no trial analyzing the analgesic contribution of IPACK to a FTB in the context of ACL reconstruction surgery.

In this multicentric trial, the investigators set out to analyze the analgesic benefit of adding an IPACK block to a FTB.

Being tested
Bupivacaine Injection, normal Saline
Keywords
nerve block, IPACK, femoral triangle
Medical subject headings
Anterior Cruciate Ligament Injuries, Acute Pain, Pain, Postoperative, Knee Injuries

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bupivacaine InjectionDrug

    Ultrasound-guided Femoral Triangle block with 20 mL of Bupivacaine 0.25% and IPACK block with 20 mL of Bupivacaine 0.25%

  • normal SalineDrug

    Ultrasound-guided Femoral Triangle block with 20 mL of Bupivacaine 0.25% and IPACK block with 20 mL of normal saline 0.9%

Study groups in NCT05068063
Study groupRoleWhat they receive
Femoral Triangle + IPACK blockExperimentalPatients randomized to receive a combination of femoral triangle block and active IPACK block
Receives: Drug: Bupivacaine Injection
Femoral Triangle blockActive comparatorPatients randomized to receive a combination of femoral triangle block and sham IPACK block
Receives: Drug: normal Saline

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Post-operative pain scores at 2 hours of arrival to Post Anesthesia Care Unit (PACU)

    Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points

    Measured: 2 hours after arrival to PACU

Secondary outcomes (17)
  1. Post-operative static pain scores at 0 hours of arrival to PACU

    Pain evaluated at rest in Numeric Rating Score from 0 to 10 points

    Measured: 0 hours after arrival to PACU

  2. Post-operative static pain scores at PACU discharge

    Pain evaluated at rest in Numeric Rating Score from 0 to 10 points

    Measured: at discharge of PACU up to 2 hours postoperatively

  3. Post-operative static pain scores at 6 hours of arrival to PACU

    Pain evaluated at rest in Numeric Rating Score from 0 to 10 points

    Measured: 6 hours after arrival to PACU

  4. Post-operative static pain scores at 12 hours of arrival to PACU

    Pain evaluated at rest in Numeric Rating Score from 0 to 10 points

    Measured: 12 hours after arrival to PACU

  5. Post-operative static pain scores at 24 hours of arrival to PACU

    Pain evaluated at rest in Numeric Rating Score from 0 to 10 points

    Measured: 24 hours after arrival to PACU

  6. Post-operative dynamic pain scores at 0 hours of arrival to PACU

    Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points

    Measured: 0 hours after arrival to PACU

  7. Post-operative dynamic pain scores at PACU discharge

    Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points

    Measured: at discharge of PACU up to 2 hours postoperatively

  8. Post-operative dynamic pain scores at 6 hours of arrival to PACU

    Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points

    Measured: 6 hours after arrival to PACU

  9. Post-operative dynamic pain scores at 12 hours of arrival to PACU

    Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points

    Measured: 12 hours after arrival to PACU

  10. Post-operative dynamic pain scores at 24 hours of arrival to PACU

    Pain evaluated during knee flexion in Numeric Rating Score from 0 to 10 points

    Measured: 24 hours after arrival to PACU

  11. Femoral Triangle Block success assessment at 2 hours

    Sensory block will be assessed with ice on the medial leg

    Measured: 2 hours after arrival to PACU

  12. Incidence of opioid related adverse events

    Incidence of adverse events related to opioid use (nausea/vomiting, pruritus, somnolence, respiratory depression, urinary retention)

    Measured: 24 hours after arrival to PACU

  13. Intraoperative opioid consumption

    Total opioid use during intraoperative period

    Measured: From anesthesia induction to extubation

  14. PACU opioid consumption

    total opioid consumption during PACU stay

    Measured: from PACU arrival to discharge up to 2 hours postoperatively

  15. Total opioid consumption

    Total opioid consumption

    Measured: 6 hours, 12 hours and 24 hours after PACU arrival

  16. Nerve block complications

    Incidence of nerve block complications (vascular puncture, puncture site erythema, hematoma, foot drop, LAST)

    Measured: From nerve block performance up to 24 hours after PACU arrival

  17. Lower limb tourniquet

    lower limb tourniquet duration

    Measured: from inflation of pneumatic device to tourniquet release

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Oct 2021
  2. Study start1 Jun 2022
  3. Primary completion30 Sep 2022 (estimated)
  4. Study completion15 Oct 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
48 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05068063
Sponsor's protocol ID
IPACK1
Status last verified
Jun 2022
First submitted
15 Sep 2021
Last updated
8 Jun 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Wilde J, Bedi A, Altchek DW. Revision anterior cruciate ligament reconstruction. Sports Health. 2014 Nov;6(6):504-18. doi: 10.1177/1941738113500910.

    PubMed 25364483
  • Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010 Jan;468(1):135-40. doi: 10.1007/s11999-009-1025-1. Epub 2009 Aug 13.

    PubMed 19680735
  • Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J, Oldfield S, Oh J, Brull R. Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction. Anesthesiology. 2016 May;124(5):1053-64. doi: 10.1097/ALN.0000000000001045.

    PubMed 26938989
  • Abdallah FW, Mejia J, Prasad GA, Moga R, Chahal J, Theodoropulos J, Dwyer T, Brull R. Opioid- and Motor-sparing with Proximal, Mid-, and Distal Locations for Adductor Canal Block in Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial. Anesthesiology. 2019 Sep;131(3):619-629. doi: 10.1097/ALN.0000000000002817.

    PubMed 31246607
  • Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Borglum J. Redefining the adductor canal block. Reg Anesth Pain Med. 2014 Sep-Oct;39(5):442-3. doi: 10.1097/AAP.0000000000000119. No abstract available.

    PubMed 25140514
  • Johnston DF, Sondekoppam RV, Uppal V, Litchfield R, Giffin R, Ganapathy S. Effect of combining peri-hamstring injection or anterior obturator nerve block on the analgesic efficacy of adductor canal block for anterior cruciate ligament reconstruction: a randomised controlled trial. Br J Anaesth. 2020 Mar;124(3):299-307. doi: 10.1016/j.bja.2019.11.032. Epub 2020 Jan 21.

    PubMed 31980156
  • Johnston DF, Black ND, Cowden R, Turbitt L, Taylor S. Spread of dye injectate in the distal femoral triangle versus the distal adductor canal: a cadaveric study. Reg Anesth Pain Med. 2019 Jan;44(1):39-45. doi: 10.1136/rapm-2018-000002.

    PubMed 30640651
  • Chan E, Howle R, Onwochei D, Desai N. Infiltration between the popliteal artery and the capsule of the knee (IPACK) block in knee surgery: a narrative review. Reg Anesth Pain Med. 2021 Sep;46(9):784-805. doi: 10.1136/rapm-2021-102681. Epub 2021 May 14.

    PubMed 33990439
  • Bushnell BD, Sakryd G, Noonan TJ. Hamstring donor-site block: evaluation of pain control after anterior cruciate ligament reconstruction. Arthroscopy. 2010 Jul;26(7):894-900. doi: 10.1016/j.arthro.2009.11.022. Epub 2010 May 13.

    PubMed 20620788

Questions about this trial

What is this clinical trial studying?

A study testing Bupivacaine Injection and normal Saline in people with Anterior Cruciate Ligament Rupture and Acute Pain, run by University of Chile at 2 sites in Chile.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 8 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Chile. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Sebastian L Layera, MD (+562 29788221, sebastianlayera@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Post-operative pain scores at 2 hours of arrival to Post Anesthesia Care Unit (PACU) (time frame: 2 hours after arrival to PACU). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05068063, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jun 2022.

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