The Effect of the IPACK Block on Pain After Primary TKA: A Double-Blinded, Prospective, Randomized Trial

Patterson, Matthew E.; Vitter, Jillian S.; Bland, Kim; Nossaman, Bobby D.; Thomas, Leslie; Chimento, George

doi:10.1016/j.arth.2020.01.014

Cited by 58 publications

(87 citation statements)

References 20 publications

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“…On contrary to the present study, Patterson et al 18 performed a study to assess the analgesic effect of IPACK block with TKA. Their study involved two groups, one of them received continuous ACB with IPACK block and the other group received continuous ACB with subcutaneous normal saline injection as placebo at site of IPACK.…”

Section: Discussionmentioning

confidence: 74%

Value of IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block in total knee arthroplasty

Amin

Abotaleb

2021

Al-Azhar International Medical Journal

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Background: Acute postoperative pain after total knee arthroplasty (TKA) is so severe to the degree that necessitates proper analgesia which is one of the patients' human rights and prevents the drawbacks of pain on various body systems. Local anesthetic Infiltration between the Popliteal Artery and the Capsule of the Knee (IPACK) can represent a promising technique for management of postoperative pain in combination with adductor canal block (ACB) after TKA. Aim of the study: aim is to evaluate the efficiency of IPACK in combination with ACB in relieving postoperative pain after TKR, particularly posterior knee pain compared to ACB alone. Patients and Methods: Patients received an ACB (Group I) or ACB plus IPACK (Group II) as a component of a multimodal analgesic for TKA. Visual analogue scale (VAS) for postoperative pain assessment were assessed as the primary outcome and opioid consumption, time to first rescue analgesia, and patient satisfaction were assessed as secondary outcomes. Results: Regarding VAS, there were nonsignificant differences between both groups in the first 8hrs postoperative, while after 8hrs postoperative and up to 48hr postoperative, VAS scores were lower in Group II. Total morphine consumption was less in Group II which had a longer time to first rescue analgesia than Group I. Patient satisfaction 48hr postoperative was higher in Group II than in Group I. Conclusion: The combination of IPACK block with ACB has the potential of being an adequate technique for management of acute postoperative pain after TKA but this needs more researches of larger samples and use of other types of local anesthetics with different volumes and concentrations.

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Section: Discussionmentioning

confidence: 74%

Value of IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block in total knee arthroplasty

Amin

Abotaleb

2021

Al-Azhar International Medical Journal

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“…The search strategy identified 2180 unique citations. After independent and duplicate screening by two authors (RSD and BL), eight RCTs 13,[25][26][27][28][29][30][31] were identified that fulfilled eligibility criteria. Collectively, these eight RCTs consisted of 777 patients (377 patients received the iPACK block; 400 patients in the control cohort received another modality of peripheral nerve blockade or PAI for knee analgesia).…”

Section: Search Resultsmentioning

confidence: 99%

“…Other sources of bias included no true control group without a posterior knee block, and unequal dose of local anesthetic between study arms. For the primary anesthetic, five studies 13,25,28,29,31 administered neuraxial anesthesia, two studies 26,27 either administered general anesthesia or neuraxial anesthesia per the discretion of the primary anesthesia team, and one study administered general anesthesia only. 30 All RCTs excluded patients who had a history of chronic pain or utilized preoperative opioids.…”

Section: Risk Of Bias and Quality Assessmentmentioning

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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“…Yang et al 18 used a titanium cable cerclage method in the treatment of patellar comminuted fractures. They reported union rate of 100% with 100% excellent and good results.…”

Section: Resultsmentioning

confidence: 99%

Treatment of comminuted patellar fractures using modified cerclage wiring

Shawky

Allah

bissar

2021

Al-Azhar International Medical Journal

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Background: Comminuted patellar fracture is still challenging. It is essential to restore the articular cartilage with rigid internal fixation. Aim of the study: was to assess the outcome of modified cerclage wiring fixation in patients with comminuted patellar fracture. Patients and Methods: This study was done in orthopedic surgery department at Al-Azhar University Hospitals, during the period from December 2019 to November 2020. A total of 15 patients with comminuted fracture of patella were maneged by modified cerclage wiring. 12 patients were males (80.0%) and 3 patients were females (20.0%). Their age was 18-64 (average 38.87±14.80) years. All patients had unilateral patellar fractures. The fractures were closed in 12 patients (80.0%) and open in 3 patients (20.0%). We followed up our patients for at least 6 months. Böstman grading score was the main clinical outcome indicator. Results: The fracture union occurred radiologically about 2-3.5 months (mean 2.70±0.46 months). 2 cases had self-limited postoperative superficial infection. No postoperative complications such as fragment re-displacement, implants breakage, , painful hardware and non-union were observed. Clinical outcomes according to grading score of Böstman were satisfactory and the average score was 28.13±1.73 (range 24-30) points. 12 patients had excellent results with an average score of 28.8 ± 0.71 (range 28-30) points and 3 patients had good results with an average score of 25.33±1.53 (range 24-27) points. All patients had knee flexion 110-140 (mean 127.33±9.61) degrees. Conclusion: Modified cerclage wiring fixation offers a new technique in comminuted patellar fracture treatment with satisfactory results and minimal complications.

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The Effect of the IPACK Block on Pain After Primary TKA: A Double-Blinded, Prospective, Randomized Trial

Cited by 58 publications

References 20 publications

Value of IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block in total knee arthroplasty

Value of IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block in total knee arthroplasty

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

Treatment of comminuted patellar fractures using modified cerclage wiring

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