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

Et, Tayfun; Korkusuz, Muhammet; Başaran, Betül; Yarımoğlu, Rafet; Toprak, Hatice; Bilge, Ayşegül; Kumru, Nuh; Dedeli, İlker

doi:10.1007/s00540-022-03047-6

Cited by 21 publications

(5 citation statements)

References 32 publications

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“…A subsequent double-blinded RCT comparing ACB, iPACK plus ACB, and PAI plus ACB in patients having TKA with spinal anesthesia, showed pain and postoperative opioid consumption was significantly lower in the iPACK with ACB (197.14 ± 61.8 mg) versus the ACB (380 ± 83.3 mg) and PAI plus ACB (268.6 ± 75.8 mg) groups, P < 0.001. Further, the patients in the iPACK plus ACB group had significantly shorter time to discharge and to first mobilization than ACB and PAI plus ACB groups [39].…”

Section: Ipack Block (Interspace Between the Popliteal Artery And Cap...mentioning

confidence: 83%

Motor-sparing peripheral nerve blocks for hip and knee surgery

Restrepo-Holguin,

Kopp,

Johnson

2023

Current Opinion in Anaesthesiology

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Purpose of review To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients. Recent findings Distal peripheral nerve blocks may allow for preserved quadriceps motor strength and comparable analgesia to traditional techniques. However, few studies in hip and knee populations include strength or function as primary outcomes. For hip surgeries, studies have failed to show analgesic differences between regional blocks and periarticular infiltration. Similarly for knee arthroplasty in the absence of periarticular infiltration, recent evidence suggests adding combinations of blocks (ACB plus iPACK or genicular nerve blocks) may balance pain control and early ambulation. Summary The use of motor-sparing peripheral nerve block techniques enables early ambulation, adequate pain control, and avoidance of opioid-related side effects facilitating outpatient/ambulatory lower extremity surgery. Further studies of these techniques for continuous peripheral nerve block catheters are needed to assess if extended blockade continues to provide motor-sparing and opioid-sparing benefits.

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Section: Ipack Block (Interspace Between the Popliteal Artery And Cap...mentioning

confidence: 83%

Motor-sparing peripheral nerve blocks for hip and knee surgery

Restrepo-Holguin,

Kopp,

Johnson

2023

Current Opinion in Anaesthesiology

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“…In recent literature, the combination of ACB + IPACK has been shown to be more effective in improving pain scores than ACB alone [9,10,20]. Et et al [21] compared ACB, ACB + IPACK, and periarticular infiltration (PAI) + ACB groups and found significantly lower movement numeric rating scale (NRS) scores in the IPACK + ACB group than in the PAI + ACB and ACB groups.…”

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 improvement of a knee's range of motion and postoperative numeric rating scale (NRS) ratings is primarily achieved by expanding an IPACK block, and ambulation distances when contrasted with the ACB alone [12] . In a review contrasting IPACK and PAIs block and ACB alone after all out knee arthroplasty, Korkusuz et al [13] , partitioned the members into three gatherings: the ACBjust gathering, the (IPACK + ACB) bunch, and the (PAI + ACB) bunch. Pretreatment NRS very still and during development didn't fundamentally vary between the gatherings.…”

Section: Discussionmentioning

confidence: 99%

“…This could be made sense of by the engine saving impact of IPACK over ACB, which influences strong strength [13] . In expansion, Elliot et al [14] announced no distinctions between patients who went through IPACK and FNB (Femoral nerve block) after absolute knee arthroplasty and the people who got IPACK and ACB with regards to NRS appraisals or narcotic use.…”

Section: Discussionmentioning

confidence: 99%

Comparison of adductor canal block, peri–articular injection or infiltration between popliteal artery and posterior knee capsule with adductor canal block in total knee arthroplasty

Badr¹,

Fattoh²,

Mohammed³

et al. 2023

Int. J. Med. Anesthesiology

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Background: Moderate to severe postoperative pain is experienced by patients after total knee arthroplasty (TKA), which has an impact on postoperative rehabilitation, patient satisfaction, and overall results. Aim: Patients receiving total knee arthroplasty under general anesthesia were evaluated to see how well the combined adductor canal block and infiltration of the interspace between popliteal artery and the capsule of posterior knee block (IPACK) reduced post-operative discomfort. These treatments were compared to adductor canal block (ACB) and peri-articular injections alone (PAIs). Patients and methods: 60 patients were randomly allocated into three groups (20 in each). All that Group I patients got was an adductor block. Patients in Group II only received the periarticular injection. The IPACK (interspace between popliteal artery and posterior knee capsule) block and adductor block procedures were performed on patients in Group III. The Numeric Rating Scale (NRS) was used to measure post-operative pain as the primary endpoint both during physical therapy and when the patient was at rest. Mobilization was assisted by the Timed Up-and-Go (TUG) and MRC tests, and the second objective was postoperative analgesia, which was assessed by the total number of analgesics used and the time it took until the first rescue analgesic was delivered. Results: The total amount of morphine consumed in IQR amongst the three study groups was statistically different (p-value 0.005). Total postoperative morphine consumption in groups II and III was statistically significantly lower than in groups I (p-value 0.005), and there was also a significant difference between groups II and III (p-value 0.005), indicating that group II had significantly less total morphine consumption than the other two groups. Conclusion:In contrast to combination IPACK-ACB and ACB alone, we came to the conclusion that adding PAIs to the pain management regimen for patients having TKA enhances analgesia quality and reduces opioid intake. Even though the combined IPACK-ACB block was less successful than PAIs, it nevertheless showed superior pain scores at rest and during physiotherapy and required less opioid consumption than ACB alone, making it a viable option to PAIs in situations where this technique is not practical.

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

Cited by 21 publications

References 32 publications

Motor-sparing peripheral nerve blocks for hip and knee surgery

Motor-sparing peripheral nerve blocks for hip and knee surgery

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

Comparison of adductor canal block, peri–articular injection or infiltration between popliteal artery and posterior knee capsule with adductor canal block in total knee arthroplasty

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