The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty

Zheng, Fang-Yu; Liu, Yongbo; Huang, Hui; Xu, Shuai; Ma, Xiaojun; Liu, Yingzhi; H, Chu

doi:10.1016/j.bjane.2021.04.012

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…Recent studies suggest that the adductor canal block and infiltration between the popliteal artery and capsule of the knee (IPACK) offer safe and effective pain management following TKA. [ 13 , 14 ] However, the safety of these PNBs, which involve drug administration without direct peripheral nerve visualization, is not assured in patients with CIDP. Notably, one study documented delayed foot drop due to the spread of the local anesthetic agent in adductor canal block and IPACK.…”

Section: Discussionmentioning

confidence: 99%

Lower extremity peripheral nerve block for total knee arthroplasty in a patient with chronic inflammatory demyelinating polyneuropathy: A case report

(Nakamura) Inaba,

Ishida,

Toba

2024

Medicine

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Rationale: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disorder that affects the peripheral nerves, leading to weakness and sensory symptoms. CIDP is a rare disease, and few studies have reported on anesthetic management in patients with this condition, especially the peripheral nerve block (PNB). Therefore, a safe and standardized anesthetic approach remains to be established. This case report aims to address this gap in evidence by documenting our experience with PNB in a patient with CIDP undergoing surgery. It contributes significantly to expanding the range of anesthetic options and enhancing perioperative outcomes for patients with CIDP. Patient concerns: A 58-year-old woman diagnosed with CIDP was scheduled to undergo left total knee arthroplasty due to osteonecrosis. We anticipated postoperative pain and aggravation of neurological symptoms. Diagnosis: CIDP. Interventions: To manage the postoperative pain, we planned a combination of general anesthesia (GA) and lower extremity PNBs, viz. the tibial and femoral nerve blocks, supplemented with intravenous patient-controlled analgesia. An initial dose of fentanyl 50 µg was administered as analgesia. The tibial and femoral nerves were identified using a peripheral nerve stimulator in conjunction with an ultrasonic echo device while the patient was conscious, to minimize the risk of nerve injury. The tibial and femoral nerve blocks were performed with 20 mL of ropivacaine (0.25%) and dexamethasone 2.2 mg, respectively. Subsequently, we administered fentanyl and ketamine and initiated continuous infusion of remifentanil. Thereafter, propofol 120 mg was administered intravenously over a span of 1 minute, followed by continuous infusion at 4 mg/kg/h. Upon confirming loss of consciousness, we induced GA using a supraglottic airway device without using muscle relaxants. For postoperative analgesia, we administered acetaminophen 1000 mg. Outcomes: The patient experienced no pain immediately after surgery, and good analgesia was achieved subsequently without worsening of sensory symptoms during rehabilitation. Lessons: We achieved effective anesthetic management in a patient with CIDP by combining GA with nerve stimulation and ultrasound-guided PNB. It is crucial to devise a personalized anesthesia plan that focuses on the patients’ safety and comfort while minimizing risk in patients with CIDP.

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Section: Discussionmentioning

confidence: 99%

Lower extremity peripheral nerve block for total knee arthroplasty in a patient with chronic inflammatory demyelinating polyneuropathy: A case report

(Nakamura) Inaba,

Ishida,

Toba

2024

Medicine

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“…A new ultrasound-guided technique has been devised that comprises infiltration of the local anesthetic between the popliteal artery and capsule of the posterior knee and provides effective analgesia to the posterior aspect of the knee without affecting muscle strength ( 25 ). Combining ACB with IPACK block provides adequate analgesia to the anterior and posterior aspects of the knee without affecting muscle strength ( 5 , 6 , 26 ). In the meta-analysis, Hussain et al reported that in the absence of LIA, adding IPACK to ACB reduces pain for up to 24 h, enhances functional recovery, and does not support the addition of IPACK to ACB when LIA is routinely administered ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks

Sreckovic,

Ladjevic,

Milicic

et al. 2024

Front. Med.

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IntroductionPeripheral nerve blocks are an efficient method of pain control after total knee arthroplasty (TKA), but there is no report of their impact on chronic post-surgical pain (CPSP).MethodsThis prospective observational study aimed to assess adductor canal block (ACB) and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, chronic post-surgical pain 2 years after TKA.Results166 patients (82 vs. 84) were analyzed. Opioid consumption was less in the group with blocks (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg).ConclusionPeripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP 2 years after surgery.

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“…Salman et al [8] compared the FNB, FNB + IPACK, and ACB + IPACK groups and found better physiotherapy performance in the ACB + IPACK group. Zheng et al [24] compared the ACB + IPACK, and FNB + single-injection popliteal sciatic nerve block (SPSNB) groups and found better quadriceps femoris muscle strength scores in the ACB + IPACK group. Similarly, Reddy et al [25] showed that the ambulation rate was better in combinations that included IPACK.…”

Section: Discussionmentioning

confidence: 99%

Effects of adductor canal block combined with infiltration between the popliteal artery and capsule of the knee on pain management and early rehabilitation compared with epidural analgesia for patients undergoing total knee arthroplasty: a prospective randomised controlled trial

2023

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Total knee arthroplasty (TKA) is often regarded as one of the most painful orthopedic operations. Variety of regional anesthetic procedures are used to reduce this pain. Infiltration between the popliteal artery and capsule of the posterior knee (IPACK) is increasingly being utilized in conjunction with adductor canal block (ACB) to provide adequate analgesia for TKA. The aim of study is to assess the analgesic effectiveness of ACB + IPACK block and epidural analgesia (EA) after TKA during the early stages of physical therapy. This prospective study included 58 patients who underwent unilateral TKA surgery. Patients were randomized into two groups as EA group (n = 30) and ACB + IPACK group (n = 28). The visual analogue scale (VAS) scores of the patients at the postoperative 8th (PO8th) hour, 1st postoperative day (POD1), and postoperative 2nd day (POD2) during the active and passive physical therapy movements, VAS scores during the ambulation, and active and passive range of movement values in POD1 were recorded. In addition, ambulation rates of the patients at the PO8th hour, 25 meters ambulation times in POD1, and completion times of 10 assisted squats in POD1 were recorded. The ACB + IPACK group had a substantially higher PO8th hour VAS score (p = 0.038). However, there was no significant difference in POD1, POD2 VAS scores. The analgesics consumption and VAS scores during ambulation were comparable among groups. Ambulation rate (22 (78.5%) vs. 16 (53.3%), p = 0.043) and speed (139.65 ± 57.12 sec. vs. 188.66 ± 77.95 sec., p = 0.023) were significantly better in the ACB + IPACK group. The strength of quadriceps contractions was similar in both groups. The use of a combination of ACB + IPACK block for postoperative analgesia in TKA patients is not only successful in reducing postoperative pain, but also a promising treatment with favourable effects on early ambulation and rehabilitation.

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The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty

Cited by 8 publications

References 16 publications

Lower extremity peripheral nerve block for total knee arthroplasty in a patient with chronic inflammatory demyelinating polyneuropathy: A case report

Lower extremity peripheral nerve block for total knee arthroplasty in a patient with chronic inflammatory demyelinating polyneuropathy: A case report

Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks

Effects of adductor canal block combined with infiltration between the popliteal artery and capsule of the knee on pain management and early rehabilitation compared with epidural analgesia for patients undergoing total knee arthroplasty: a prospective randomised controlled trial

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