Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia and Function Recovery Following Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study

Mou, Ping; Tang, Xiaoyun; Zeng, Wenbin; Zeng, Yan; Yang, Jing; Zhou, Kai

doi:10.1016/j.arth.2021.10.004

Cited by 28 publications

(28 citation statements)

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“…31 Third, we did not assess the effects of volume on MEC 90 , injecting always the same total volume of 40 mL based on previous studies. 10,15,19,29,30,31,39 Other volumes of local anesthetic have been reported for ACB and IPACK block, 20,38,40,41 so it is unclear whether our results can generalize to other volumes. Future work should address these limitations, as well as verify and extend our findings for a range of multimodal pain regimens.…”

Section: Discussionmentioning

confidence: 78%

“…Like most previous studies on ACB + IPACK block (Table 4), 15,19,20,29–31,38,39 local infiltration analgesia was not used in this study. It is not clear whether the analgesic efficacy of ACB + IPACK block combined with local infiltration analgesia is better, or whether the MEC 90 for ACB + IPACK block was the same as ACB + IPACK block combined with local infiltration analgesia.…”

Section: Discussionmentioning

confidence: 99%

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Minimum effective concentration of ropivacaine for ultrasound-guided adductor canal + IPACK block in total knee arthroplasty

Wang

Cai

et al. 2022

J Orthop Surg (Hong Kong)

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Objective This study aimed to investigate the minimum effective concentration (MEC90, defined as effective in 90% of patients) of ropivacaine during the combined procedure of adductor canal block (ACB) and infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block for patients undergoing total knee arthroplasty. Methods This double-blind, randomized dose-finding trial was based on a biased coin up-and-down sequential design, where the concentration of ropivacaine administered to a given patient depended on the previous patient’s response. Before surgery, the first patient received 20 mL of 0.2% ropivacaine for ACB and again for IPACK. If the block failed, the next subject received a 0.025% higher ropivacaine concentration; otherwise, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89). The primary outcome was whether the block was successful. Block success was defined as the patient did not suffer significant pain and did not receive rescue analgesia within 6 h after surgery. MEC90 was estimated by isotonic regression, and the 95% confidence interval (CI) was calculated by bootstrapping. Secondary outcomes were numerical rating scale (NRS) pain scores at postoperative 24 h and 48 h, postoperative morphine consumption, and time to hospital discharge. Secondary outcomes were compared between patients whose blocks succeeded with those which failed. Results Based on analysis of 52 patients, the MEC90 was 0.247% (95% CI 0.227–0.271%), MEC95 was 0.260% (95% CI 0.244–0.282%) and MEC99 was 0.272% (95% CI 0.260–0.291%). In contrast, four of nine trials in a recent systematic review reported ropivacaine concentrations below 0.247%. Patients whose blocks succeeded ( n = 45) had significantly lower NRS pain scores, lower morphine consumption, and shorter hospitalization than patients whose blocks failed ( n = 7). Conclusions Our small trial suggests that 0.247% ropivacaine in 20 mL respectively can provide successful ACB + IPACK block in 90% of patients. However, given that many published trials have used lower concentrations, our findings should be verified in larger studies.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Minimum effective concentration of ropivacaine for ultrasound-guided adductor canal + IPACK block in total knee arthroplasty

Wang

Cai

et al. 2022

J Orthop Surg (Hong Kong)

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“…The other laboratory indexes, such as hemoglobin, albumin, IL‐6, and CRP, were similar between the two groups. These benefits may come from the comprehensive care of ERAS implemented in our center and multidisciplinary team cooperation 11 , 12 , 13 , 40 , 41 . One of the main concerns of using carbohydrate supplements is the uncertainty of how blood glucose levels will react.…”

Section: Discussionmentioning

confidence: 99%

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Tang

Ning

et al. 2022

Orthopaedic Surgery

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Objective Patients undergoing total knee arthroplasty (TKA) were primarily geriatric, with high risk of postoperative electrolyte disorders and malnutrition. Randomized controlled trials regarding oral nutrition supplement (ONS) strategies in TKA was sparse. This study aimed to evaluate the efficacy of preoperative oral electrolyte‐carbohydrate nutrition supplement (OECNS) on patients (aged >65 years) undergoing TKA. Methods From April 2019 to January 2020, 94 patients undergoing primary elective unilateral TKA in our hospital were considered in this prospective randomized controlled study. This study included patients aged over 65 years with ASA I‐III, and excluded patients with electrolyte disorders, malnutrition, and comorbidities. The control group (control group) received meal nutrition supplements (preoperative 6 h [Pre 6h]) and water (Pre 2h), while OECNS group (intervention group) received meal nutrition supplements (Pre 6h) and OECNS (Pre 2). The Student's t test and χ2 test was used. The primary outcomes were the patient‐reported comfort indicators (PRCIs) including hunger, thirst, nausea, vomiting, weakness, pain, anxiety, and general comfort. The secondary outcomes included indicators of electrolyte, nutrition, functional scores, clinical results, and complications. Results The scores of preoperative hunger (0.43 ± 0.10), pain (2.30 ± 0.34), and anxiety (9.04 ± 2.71) were significantly lower in OECNS group compared with control group (hunger, 1.19 ± 0.21; pain, 3.79 ± 0.26; anxiety, 11.21 ± 3.02) (Pre 1h) (all p < 0.05) as well as the weakness score on the first postoperative day (POD1) (OECNS group 3.57 ± 0.24; control group 5.15 ± 0.29; p < 0.001). A higher level of Na + (OECNS group 140.54 ± 3.39; control group 138.07 ± 5.21; p = 0.008) and a reduced rate of hyponatremia (OECNS group 6.4%; control group 21.3%; p = 0.036) on POD1 were found. Moreover, the higher level of blood glucose (Post 2h) and reduced rates of abnormal blood glucose (Pre 2h, Post 6h) were verified in control group (all p < 0.05). There was no significant difference regarding the other outcomes. Conclusion The administration of OECNS significantly improved subjective comfort, electrolytes, and blood glucose without increasing the rates of complications in patients (aged over 65 years) undergoing TKA.

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“…Therefore, we also chose this volume based on previous studies. 12,[18][19][20]28,30,32,36 Other volumes of ropivacaine have also been selected for these nerve blocks. 22,31 Whether the results of this study are applicable to other volumes of ropivacaine and the optimal volume requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…22,31 Whether the results of this study are applicable to other volumes of ropivacaine and the optimal volume requires further investigation. Like most previous studies, [18][19][20]22,28,30,31,36 local infiltration analgesia was not used in this study. It is not clear whether the analgesic efficacy of ACB þ IPACK block combined with local infiltration analgesia is better.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Concentrations of Ropivacaine Used for Ultrasound-Guided Adductor Canal Block + IPACK Block in Total Knee Arthroplasty

Wang

et al. 2022

J Knee Surg

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Introduction This study aimed to compare the analgesic efficacy of different concentrations of ropivacaine used for the combination of ultrasound-guided adductor canal block (ACB) and infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block in total knee arthroplasty (TKA). Materials and Methods Before general anesthesia, 90 patients undergoing TKA were randomized to receive ACB + IPACK block with ropivacaine 0.2, 0.25, or 0.3% (defined as group A, B, and C, respectively). Primary outcome was the reported visual analog scale (VAS) pain scores at rest 30 minutes following arrival to the postanesthesia care unit (PACU). Secondary outcomes were postoperative VAS pain scores, postoperative morphine consumption, the time to first rescue analgesia, functional recovery of knee (including the range of motion and quadriceps strength), and postoperative complications. Results Compared with group A, group B and group C had significantly lower VAS scores 30 minutes following arrival to the PACU (p < 0.001 and p < 0.001, respectively). These two groups also had significantly lower VAS pain scores at postoperative 2 hours (at rest: p = 0.037 and 0.002; during motion: p = 0.035 and 0.001, respectively) and 6 hour (at rest: p = 0.033 and 0.002; during motion: p < 0.001 and p < 0.001, respectively), lower postoperative morphine consumption (p = 0.001 and 0.002, respectively), longer time to first rescue analgesia (p = 0.010 and 0.009, respectively), and better range of knee motion on the day of surgery (p = 0.008 and 0.002, respectively). Group B and group C showed no significant differences in these outcomes between each other (p > 0.05). The three groups did not show a significant difference in postoperative quadriceps strength and complication rates (p > 0.05). Conclusion Compared with ropivacaine 0.2%, ropivacaine 0.25 and 0.3% can provide early pain relief in the first 6 hours after surgery. Ropivacaine 0.25 and 0.3% may provide more clinical benefits for patients undergoing outpatient TKA.

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Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia and Function Recovery Following Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study

Cited by 28 publications

References 31 publications

Minimum effective concentration of ropivacaine for ultrasound-guided adductor canal + IPACK block in total knee arthroplasty

Minimum effective concentration of ropivacaine for ultrasound-guided adductor canal + IPACK block in total knee arthroplasty

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Comparison of Different Concentrations of Ropivacaine Used for Ultrasound-Guided Adductor Canal Block + IPACK Block in Total Knee Arthroplasty

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