However, patients who received ACB + iPACK block may require higher amounts of opioids and have worse immediate functional performance.Īdductor canal block analgesia iPACK (interspace between the popliteal artery and capsule of the posterior knee) block periarticular injection total knee arthroplasty ultrasound-guidance.Ĭopyright © 2020 Elsevier Inc. 04, respectively) in the ACB + iPACK group.ĪCB with iPACK block provides a noninferior analgesia compared with PAI when combined with CACB. iPACK Block Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, 3e AccessAnesthesiology McGraw Hill Medical Read chapter 31 of Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, 3e online now, exclusively on AccessAnesthesiology. The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta. 05) and showed greater reduced quadriceps strength at 0 and 45 degrees on postoperative day 0 (P =. However, morphine requirement at 48 postoperative hours was significantly higher (P <. The mean visual analog scale pain scores were low and no clinically significant differences between groups. The upper limit of 95% confident interval was lower than the prespecified noninferiority limit. Pain scores, morphine consumption, functional performance, and adverse events were the secondary outcome measures assessed for superiority.Īdjusted mean differences, (ACB + iPACK) - (ACB + PAI), in anterior and posterior knee pain scores on movement at 12 postoperative hours were -0.66 (-1.86, 0.54) and -0.19 (-1.36, 0.99), respectively.
Noninferiority was concluded for the primary outcome if the adjusted mean between-group difference in pain on movement at 12 postoperative hours was within 1.3 points on a visual analog pain scale. Seventy-six patients were randomized to receive either ACB + iPACK block and continuous ACB (CACB) (ACB + iPACK group) or PAI and CACB (ACB + PAI group). This study aimed to determine if ACB with iPACK block was noninferior to ACB with periarticular injection (PAI) when combined with postoperative multimodal analgesia regimen.
CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.The combination of adductor canal block (ACB) and infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block may provide sufficient motor-sparing anterior and posterior knee analgesia after total knee arthroplasty. However, there was no significant pain noted in two groups to provide the rescueanalgesics. The VAS score atrest after 8 th hr, 12 th hr and 24 th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. RESULT: The mean age of the patients in the study group was 58.7 years. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. Pain assessment was done by a 10 cm visual analogue scale (VAS) 0: no pain 10: worst imaginable pain. The patients were selected by closed envelope method into two groups as group 1 patients received ACB+IPACK and group 2 received ACB only. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis.
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