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. After 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 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.
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.
Ipack block ultrasound trial#
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.
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