Pain management in total knee arthroplasty. A comprehensive review

Domagalska, Małgorzata; Reysner, Tomasz

doi:10.31139/chnriop.2022.87.4.6

Cited by 2 publications

(2 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sciatic and femoral nerve blockade is the standard for adequate analgesia after total knee arthroplasty. However, the motor block that develops after femoral and sciatic nerve blocks prevent early ambulation [6].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial

Domagalska,

Reysner,

Kowalski

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

Introduction: This study aimed to investigate pain management, functional recovery, and stress response expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) after the popliteal artery and posterior knee capsule infiltration (iPACK) block combined with adductor canal block (ACB) in total knee arthroplasty (TKA). Patients and Methods: This was a prospective, double-blinded, randomised, controlled trial in a tertiary referral hospital. Three hundred and sixty-six patients were randomly allocated into the sham block group and iPACK combined with the ACB group. The primary outcome was postoperative pain scores. The secondary outcomes were opioid consumption, functional recovery expressed by a range of motion, and quadriceps strength. Also, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. Results: There were significant differences between the sham block and iPACK + ACB group in pain scores p < 0.0001 at all time points. Therefore, there was a significant difference in opioid consumption (p < 0.0001) and functional recovery (p < 0.0001). Also, NLR and PLR levels 12 h (p < 0.0001) and 24 h (24 h) after surgery (p < 0.0001) were much lower in the iPACK + ACB group. Conclusion: After total knee arthroplasty, the iPACK combined with ACB block group improved pain management, functional recovery, and stress response. Therefore, we strongly recommend this technique as a part of a multimodal analgesia protocol in knee surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Multimodal analgesia has been assimilated into most clinical lanes to improve patient comfort, satisfaction, and ambulation [3]. Different analgesic strategies, including motor-sparing local infiltration analgesia (LIA) and peripheral nerve blocks, lower pain scores, and opioid consumption, thus support early functional recovery [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial

Domagalska,

Reysner,

Kowalski

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

Periarticular injection, iPACK block, and peripheral nerve block in pain management after total knee arthroplasty: a structured narrative review

Domagalska,

Wieczorowska-Tobis,

Reysner

et al. 2023

Perioper Med

View full text Add to dashboard Cite

Introduction Total knee arthroplasty (TKA) is commonly performed in patients with end-stage osteoarthritis or rheumatoid arthritis of the knee to reduce joint pain, increase mobility, and improve quality of life. However, TKA is associated with moderate to severe postoperative pain, which remains a significant clinical challenge. Surgeon-administered PAI and anesthesiologist-administered iPACK have proven viable alternatives to conventional peripheral nerve blocks. This review aims to discuss which IPACK block or periarticular injection, combined or not with different peripheral nerve blocks, has better effects on postoperative rehabilitation, patient satisfaction, and overall outcome. Material and methods The literature review was performed on standards of care, current therapeutic options, a pain management protocol, and innovative treatment options for patients undergoing total knee arthroplasty. The literature was reviewed through four electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase. Results The initial search yielded 694 articles. Fifty relevant articles were selected based on relevance, recentness, search quality, and citations. Six studies compared PAI to peripheral nerve block (PNB), and eight studies checked the effectiveness of adding PNB to PAI. Three studies compared iPACK to PNB, and ten reviewed the point of adding PNB to iPACK. Conclusions The literature review indicates that the best analgesic effect is obtained by combining PAI or iPACK with a peripheral nerve block, particularly with ACB, due to its analgesic, motor-sparing effect, and satisfactory analgesia.

show abstract

Pain management in total knee arthroplasty. A comprehensive review

Cited by 2 publications

References 50 publications

Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial

Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial

Periarticular injection, iPACK block, and peripheral nerve block in pain management after total knee arthroplasty: a structured narrative review

Contact Info

Product

Resources

About