Adductor canal block: Effect of volume of injectate on sciatic extension

Raddaoui, K.; Radhouani, Mohamed; Bargaoui, A.; Nasri, Oussama; Zoghlami, Karima; Trigui, Emna; Kaabachi, O.

doi:10.4103/sja.sja_410_19

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…This may reflect a component of continuous local anesthetic spread from the adductor canal to the genicular branches of the posterior obturator nerve as well as the popliteal plexus, which has been demonstrated in cadaveric studies 41 and in patients undergoing TKA. 42 This spread would potentially negate the benefit of the iPACK block for posterior compartment analgesia. We also noted that Tak and colleagues 28 reported a higher cumulative OME in patients who received an iPACK+ACB block versus control patients who received cACB at discharge only (time not specified); this outcome may be due to the limited duration of both single-injection iPACK and single-injection ACB versus extended duration provided by a continuous ACB catheter.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

D’Souza¹,

Langford²,

Olsen³

et al. 2021

LRA

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Posterior knee pain after total knee arthroplasty (TKA) is common despite multimodal analgesia and regional anesthesia use. This review included randomized controlled trials (RCTs) comparing analgesic outcomes after inclusion of local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block versus pathways without iPACK. Electronic databases (MEDLINE, Cochrane Library, Web of Science, Scopus) were searched from inception to 10/11/2020. Eligible studies evaluated iPACK use on primary outcomes: opioid consumption and pain scores with movement. Secondary outcomes included rest pain, patient satisfaction, length of stay (LOS), gait distance, knee range of motion (ROM), and complications. Bias and quality were appraised using the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. Eight RCTs (777 patients) were included. iPACK block use demonstrated similar opioid consumption in the PACU (4/7 RCTs) and 24 hours after TKA (5/7 RCTs) compared to without iPACK (moderate-quality GRADE evidence). Additionally, iPACK block use demonstrated lower movement pain scores in PACU (3/5 RCTs) but similar or higher pain scores after 24 hours (5/7 RCTs; lowquality GRADE evidence). Studies consistently reported no difference in gait distance (4/4 RCTs) or complications (7/7 RCTs) between treatment arms (high-quality GRADE evidence), although differing effect estimates were observed with resting pain, satisfaction, LOS, and knee ROM. This review provides a foundation of knowledge on iPACK efficacy. While evidence does not currently support widespread inclusion of iPACK within enhanced recovery pathways for TKA, limitations suggest further study is warranted.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

D’Souza¹,

Langford²,

Olsen³

et al. 2021

LRA

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“…None of the injections in the distal femoral triangle spread dye into the popliteal fossa. A prospective, randomized trial injected 42 patients with either 20 or 40 mL of 0.375% ropivacaine during “adductor canal” block performed “with the FA immediately under the sartorius.” 42 This injection is likely in the distal femoral triangle. They demonstrated >50% of patients had diminished sensation in the distribution of the peroneal nerve, with a trend toward a greater proportion of patients with diminished sensation in the higher volume group.…”

Section: Pro—the Location For Injection Mattersmentioning

confidence: 99%

Pro and Con: How Important Is the Exact Location of Adductor Canal and Femoral Triangle Blocks?

Woodworth

Arner

Nelsen

et al. 2023

Anesthesia &Amp; Analgesia

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In this Pro-Con commentary article, we debate the importance of anterior thigh block locations for analgesia following total knee arthroplasty. The debate is based on the current literature, our understanding of the relevant anatomy, and a clinical perspective. We review the anatomy of the different fascial compartments, the course of different nerves with respect to the fascia, and the anatomy of the nerve supply to the knee joint. The Pro side of the debate supports the view that more distal block locations in the anterior thigh increase the risk of excluding the medial and intermediate cutaneous nerves of the thigh and the nerve to the vastus medialis, while increasing the risk of spread to the popliteal fossa, making distal femoral triangle block the preferred location. The Con side of the debate adopts the view that while the exact location of local anesthetic injection appears anatomically important, it has not been proven to be clinically relevant.

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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

Mou

Tang

Zeng

et al. 2022

The Journal of Arthroplasty

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Adductor canal block: Effect of volume of injectate on sciatic extension

Cited by 6 publications

References 19 publications

Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

Pro and Con: How Important Is the Exact Location of Adductor Canal and Femoral Triangle Blocks?

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

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