Comparing Two Regional Anesthesia Methods for Pain Relief After Total Knee Replacement in Adults 65 and Older Adductor Canal Block With Sacral Erector Spinae Plane Block Versus Adductor Canal Block With iPACK Block

What this Trial Is About

Researchers are evaluating two different regional anesthesia methods to manage pain after total knee arthroplasty TKA in adults aged 65 and older. Both methods use an adductor canal block ACB to reduce pain while preserving muscle strength. The study compares combining ACB with either a sacral erector spinae plane block S-ESPB or an iPACK block to see which provides better pain relief, reduces opioid use, and improves recovery after surgery. Participants will receive an ultrasound-guided ACB with 20 mL of 0.2% ropivacaine. They will then be randomly assigned to receive either an S-ESPB or an iPACK block, both also using 20 mL of 0.2% ropivacaine. All patients will receive standard perioperative care and multimodal pain management as part of the study. The treatments aim to provide effective pain relief while allowing early movement after surgery. During the study, researchers will monitor the time until patients first need extra pain medication within 48 hours after surgery. They will also assess pain levels at rest and during movement, opioid use, muscle strength, nausea, blood pressure events, block-related complications, time to first mobilization, and patient satisfaction. The study will last from surgery through the 48-hour postoperative period with close observation of outcomes and side effects.

ACB With S-ESPB Versus ACB With iPACK for Knee Arthroplasty