IPACK Block in Total Knee Arthroplasty

• Delirium occurence[ Time Frame: 48 hours ]
  Nu-DESK scale (presence of disorientation, inappropriate behavior, inappropriate communication,illusions/hallucinations, psychomoter retardation). Each of the 5 items is rated from 0 to 2. A total of 10 is the maximum score. A score of more than 2 identifies the presence of delirium.
• Range of knee motion[ Time Frame: 48 hours ]
  Degrees of flexion
• Complications[ Time Frame: 48 hours ]
• Patient mobilization[ Time Frame: 5 days ]
  Patient reporting time of first standing to the side of the bed and number of steps per day
• Patient satisfaction[ Time Frame: 48 hours ]
  Patients asked whether they would choose the same anaesthetic management in a future operation: Yes/No
• Joint function[ Time Frame: 6 months ]
  Maximal flexion / extension
• Intestinal function[ Time Frame: 5 days ]
  Time of first passing of rectal gas, reported by the patient

100 patients ASA I-III, undergoing total knee arthroplasty under spinal anesthesia, will be randomly assigned into one of two groups, namely group A (n=50), where an adductor canal block and an IPACK block will be performed preoperatively and group B (n=50) where an adductor canal block only will be performed preoperatively. All patients will receive a standardized multimodal approach, including pregabalin, paracetamol, and PCA with morphine. NRS scores in static and dynamic conditions during the first 48 hours postoperatively, morphine consumption during the first 24 hours postoperatively will be measured and additionally, patient satisfaction, complications, range of knee motion, moblization, functionality, delirium ocurence will be recorded. Chronic pain will be assessed in 3 and 6 months postoperatively.

• Drug: Adductor Canal Block plus IPACK Block
  Adductor Canal Block plus IPACK Block using Ropivacaine
• Drug: Adductor Canal Block
  Adductor Canal Block using Ropivacaine

• Active Comparator: Group A
• Active Comparator: Group B