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Randomized Controlled Trial
. 2022 Apr;36(2):276-286.
doi: 10.1007/s00540-022-03047-6. Epub 2022 Feb 14.

Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial

Tayfun Et  1   2 , Muhammet Korkusuz  3 , Betül Basaran  4 , Rafet Yarımoğlu  3 , Hatice Toprak  4 , Ayşegül Bilge  4 , Nuh Kumru  3 , İlker Dedeli  5
Affiliations
Randomized Controlled Trial

Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial

Tayfun Et et al. J Anesth. 2022 Apr.

Abstract

Purpose: The infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to provide analgesia without loss of muscle strength and is effective in functional recovery. This study compared iPACK + ACB (adductor canal block) with PAI (periarticular infiltration) + ACB and ACB alone in terms of postoperative analgesia and functional improvement.

Methods: This double-blinded randomized controlled trial included 105 patients undergoing unilateral total knee arthroplasty. Patients received ACB, iPACK + ACB, and PAI + ACB along with spinal anesthesia. The primary outcome was the area under the curve (AUC) numeric rating scale (NRS) at 48 h. Secondary outcomes were cumulative postoperative analgesic consumption within 48 h, timed up-and-go test, range of motion, length of hospital stay, patient satisfaction, and adverse events.

Results: The 48-h AUC movement NRS score in the iPACK + ACB group was significantly lower than in the PAI + ACB and ACB groups (p < 0.05). At the postoperative 48th h, the opioid consumption of the iPACK + ACB group was lower than those of the ACB and PAI + ACB groups (p < 0.001). The patients in the iPACK + ACB group had significantly shorter discharge and mobilization days than the ACB and PAI + ACB groups (p < 0.001).

Conclusions: The adding of an iPACK block to the ACB improves postoperative analgesia and reduces opioid consumption. In addition, this approach improves functional performance and reduces hospital stay.

Keywords: Adductor canal block; Periarticular block; Total knee arthroplasty; iPACK.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The iPACK is ultrasound image with a low-frequency curvilinear probe placed along the posterior. tn tibial nerve, cpn common peroneal nerve, pv popliteal vein, pa popliteal artery, ipack the interspace between the popliteal artery and capsule of the posterior knee
Fig. 2
Fig. 2
Consolidated standards of reporting trials flow diagram. BMI body mass index, ACB adductor canal block, iPACK, the interspace between the popliteal artery and capsule of the posterior knee block, respectively, PAI periarticular infiltration
Fig. 3
Fig. 3
Results presented as mean (95% CI) for NRS at rest and during the movement. *p value < 0.05 ACB between iPACK + ACB, †p value < 0.05 ACB between PAI + ACB, ‡p value < 0.05 iPACK + ACB between PAI + ACB. A line graph representing knee pain at rest and during the movement postoperative 48 h after total knee arthroplasty. ACB adductor canal block, iPACK infiltration between the popliteal artery and capsule of the knee block, PAI periarticular infiltration, NRS numerical rating scale
See this image and copyright information in PMC

Comment in

  • Comparing analgesic efficacy of different block modalities.
    Yuan YJ, Luo X, Xue FS. Yuan YJ, et al. J Anesth. 2022 Jun;36(3):447-448. doi: 10.1007/s00540-022-03066-3. Epub 2022 Apr 10. J Anesth. 2022. PMID: 35397687 No abstract available.
  • Response to Yuan et al.
    Et T, Basaran B. Et T, et al. J Anesth. 2022 Jun;36(3):449-450. doi: 10.1007/s00540-022-03071-6. Epub 2022 Apr 29. J Anesth. 2022. PMID: 35486257 No abstract available.

References

    1. Kopp SL, Børglum J, Buvanendran A, Horlocker TT, Ilfeld BM, Memtsoudis SG, Neal JM, Rawal N, Wegener JT. Anesthesia and analgesia practice pathway options for total knee arthroplasty: an evidence-based review by the American and European societies of regional anesthesia and pain medicine. Reg Anesth Pain Med. 2017;42:683–697. doi: 10.1097/AAP.0000000000000673. - DOI - PubMed
    1. Elmallah RK, Chughtai M, Khlopas A, Newman JM, Stearns KL, Roche M, Kelly MA, Harwin SF, Mont MA. Pain control in total knee arthroplasty. J Knee Surg. 2018;31:504–513. doi: 10.1055/s-0037-1604152. - DOI - PubMed
    1. Kehlet H, Andersen LØ. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand. 2011;55:778–784. doi: 10.1111/j.1399-6576.2011.02429.x. - DOI - PubMed
    1. Kuang MJ, Ma JX, Fu L, He WW, Zhao J, Ma XL. Is adductor canal block better than femoral nerve block in primary total knee arthroplasty? A GRADE analysis of the evidence through a systematic review and meta-analysis. J Arthroplasty. 2017;32:3238–3248. doi: 10.1016/j.arth.2017.05.015. - DOI - PubMed
    1. Abdallah FW, Madjdpour C, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A meta-analysis. Can J Anaesth. 2016;63:552–568. doi: 10.1007/s12630-016-0613-2. - DOI - PubMed

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