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. 2024 Mar;68(3):287-292.
doi: 10.4103/ija.ija_936_23. Epub 2024 Feb 22.

Triple injection peri-sartorius (TIPS) block for postoperative analgesia after total knee arthroplasty: Randomised controlled study

Ahmad Samir Alabd  1 , Moustafa Abdelaziz Moustafa  1 , Aly Mahmoud Moustafa Ahmed  1
Affiliations

Triple injection peri-sartorius (TIPS) block for postoperative analgesia after total knee arthroplasty: Randomised controlled study

Ahmad Samir Alabd et al. Indian J Anaesth. 2024 Mar.

Abstract

Background and aims: Motor-sparing analgesia after total knee arthroplasty (TKA) is crucial. The primary endpoint was the postoperative visual analogue scale (VAS) score after triple injection peri-sartorius (TIPS) block after TKA. Secondary endpoints were postoperative morphine consumption, 24-h postoperative ambulation distances and the degrees of active knee extension.

Methods: After general anaesthesia or spinal anaesthesia administration and before surgical incision, 80 patients undergoing TKA were randomised into group TIPS (received ultrasound-guided TIPS block where 40 ml 0.25% bupivacaine and 4 mg dexamethasone were injected: 10 ml at the distal femoral triangle, 10 ml above the sartorius and 20 ml at the distal adductor canal) and group FNB (femoral nerve block; received ultrasound-guided FNB with 20 ml 0.25% bupivacaine mixed with 4 mg dexamethasone). Postoperative pain score was noted and compared.

Results: Dynamic VAS scores were lower in the TIPS group than in FNB, while the resting VAS scores were not significantly different. Mean (standard deviation [SD]) postoperative morphine consumption was 5.82 (2.47) mg in the TIPS group (95% confidence interval [CI] 5.03,6.61) versus 9.87 (2.99) mg in the FNB group (95% CI 8.91,10.83). Ambulation distances and active postoperative knee extension in the TIPS group showed greater significance than in the FNB group (TIPS: 18.0 [7.37] m, 95% CI 15.64,20.35] vs. FNB: 8.95 [5.93] m, 95% CI 7.05,10.84) and (TIPS: 52.12 [16.39], 95% CI 46.88,57.33 vs. FNB: 26.05 [11.10], 95% CI 22.501,29.59). Nausea was more evident in FNB patients.

Conclusion: TIPS block provides superior analgesia than FNB with motor sparing of the quadriceps after TKA.

Keywords: Analgesia; arthroplasty; femoral nerve block; knee replacement; nerve block; peri-sartorial block; triple injection; visual analogue scale.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
TIPS block. (a) Ultrasound-guided determination of the apex of the femoral triangle where the medial border of SAM meets the medial border of ALM. (b) The probe was slid cephalad 2 cm above the apex of the femoral triangle. The needle was advanced from lateral to medial, and LA was injected under SAM lateral to femoral vessels (c) The needle was withdrawn subcutaneously and advanced superficial to SAM underneath FL, and LA was injected. (d) The probe was slid distally along SAM until femoral vessels slipped posteriorly to reach the popliteal fossa. LA was injected posterior to femoral vessels. ALM = adductor longus muscle, F = femur, FL = fascia lata, FV = femoral vessels, LA = local anaesthetic, SAM = sartorius muscle, TIPS = triple injection peri-sartorius, VM = vastus medialis
Figure 2
Figure 2
Consolidated standards of reporting trials (CONSORT) flow chart
See this image and copyright information in PMC

Comment in

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