Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement

Abstract

Background The Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block is a new anesthesiologist- administered analgesic technique for controlling posterior knee pain that has not yet been well studied in total knee arthroplasty (TKA) patients. We compared pain outcomes in TKA patients before and after implementation of the IPACK with the hypothesis that patients receiving IPACK blocks will report lower pain scores on postoperative day (POD) 0 than non-IPACK patients. Methods With Institutional Review Board approval, we retrospectively reviewed data for consecutive TKA patients by a single surgeon 4 months before (PRE) and after (POST) IPACK implementation. All TKA patients received adductor canal catheters and peri-operative multimodal analgesia. The primary outcome was pain on POD 0. Other outcomes were daily pain scores, opioid consumption, ambulation distance, length of stay, and adverse events within 30 days. Results Post-implementation, 48/50 (96%) of TKA patients received an IPACK block, and they were compared with 32 patients in the PRE group. On POD 0, the lowest pain score (median [10th–90th percentiles]) was significantly lower for the POST group compared to the PRE group (0 [0–4.3] vs. 2.5 [0–7]; P = 0.003). The highest patient-reported pain scores on any POD were similar between groups with no differences in other outcomes. Conclusions Within a multimodal analgesic protocol, addition of IPACK blocks decreased the lowest pain scores on POD 0. Although other outcomes were unchanged, there may be a role for new opioid-sparing analgesic techniques, and changing clinical practice change can occur rapidly.

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

“…It has been reported that an adductor canal block can effectively control the anterior and medial pain in the knee joint by blocking the saphenous nerve, but the effect is not sufficient for controlling moderate to severe pain after TKA, especially for the control of pain in the posterior of the knee [ 18 , 19 ]. By blocking the sensory branches behind the knee joint, the IPACK block seemed to be a powerful and lasting method (effective analgesic time of a single IPACK block is 8–12 h) to control the pain behind the knee without affecting the muscle strength below the knee, which was conducive to early postoperative functional exercise [ 20 , 21 ]. In this study, patients in the ERAS group were treated with an ultrasonic-guided adductor canal block combined with IPACK block to achieve precise anesthesia.…”

The Feasibility of Outpatient Revision Total Knee Arthroplasty in Selected Case Scenarios

“…The pain management protocol began the night before surgery with 1 g acetaminophen oral acetaminophen, and continued the day of surgery with another 1 g acetaminophen and 400 mg celecoxib. All patients received an adductor canal and IPACK block (Infiltration between the Popliteal Artery and Capsule of the Knee) in the preoperative waiting area as well as hypotensive anesthesia and a tourniquet during surgery [14]. Prior to the completion of the case, all patients receive a pericapsular block of ropivacaine plus epinephrine, and ketorolac if not renal impaired.…”

Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement

“…[ 9 ] Therefore, ultrasound-guided IPACK block seems to provide a promising motor-sparing posterior knee analgesia while reducing the possibility of nerve or vascular injury. [ 10 , 11 ]…”