Comparing Liposomal Bupivacaine and Ropivacaine with Dexamethasone or Dexmedetomidine for Knee Nerve Blocks in Total Knee Replacement Surgery

What this Trial Is About

Researchers are evaluating different pain management techniques for patients undergoing total knee arthroplasty TKA. The study compares three local anesthetic approaches liposomal bupivacaine alone, ropivacaine with perineural dexamethasone, and ropivacaine with perineural dexmedetomidine. These methods are used in adductor canal block ACB and infiltration between the popliteal artery and capsule of the knee IPACK blocks to provide motor-sparing analgesia. The goal is to find the optimal approach to improve pain control and reduce opioid use after surgery. Participants will be randomly assigned to one of two groups one receiving liposomal bupivacaine 6.65% and the other receiving ropivacaine 0.375% combined with either dexamethasone 4 mg or dexmedetomidine 1 mcgkg. Each participant will receive a total of 40 mL of anesthetic divided equally between the ACB and IPACK blocks. These ultrasound-guided nerve blocks are administered before the surgical incision. During the study, researchers will monitor total opioid consumption over 72 hours as the main outcome. Additional assessments include pain scores at rest and movement, time to first ambulation, hospital stay duration, patient satisfaction with pain management, and quality of recovery. The study uses a quadruple-blind design to ensure unbiased results and will continue until December 2026. Participants undergo evaluations throughout their hospital stay and recovery period to track safety and effectiveness.

Liposomal Bupivacaine Versus Ropivacaine With Perineural Dexamethasone or Dexmedetomidine as Adjuncts for Adductor Canal Block Combined With IPACK Block in Total Knee Arthroplasty