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

Abstract

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. 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.