Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia and Function Recovery Following Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study

• Published in: The Journal of arthroplasty Vol. 37; no. 2; pp. 259 - 266
• Main Authors: Mou, Ping, Wang, Duan, Tang, Xiu-Mei, Zeng, Wei-Nan, Zeng, Yan, Yang, Jing, Zhou, Zong-Ke
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022
• Subjects: adductor canal block; Analgesia; Analgesics, Opioid; Anesthetics, Local; Arthroplasty, Replacement, Knee - adverse effects; function recovery; Humans; IPACK block; Nerve Block; Pain, Postoperative - epidemiology; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Prospective Studies; Recovery of Function; total knee arthroplasty; IPACK block; function recovery; total knee arthroplasty; adductor canal block; analgesia
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2021.10.004

This study aimed to explore the analgesic effect among adductor canal block (ACB) combined with infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block, ACB, and IPACK block following total knee arthroplasty (TKA). One hundred twenty patients were randomly allocated into 3 groups including group A (ACB + IPACK block), group B (ACB), and group C (IPACK block). The primary outcome was postoperative pain score. The secondary outcome was opioid consumption. Other outcomes included functional evaluation and postoperative complications. Group A showed the lowest pain scores within 8 hours at rest and with knee maximum flexion (P < .001). From 12 to 24 hours, group C showed the highest pain scores, while no significant difference was found between group A and group B. No significant difference was found among the 3 groups 24 hours postoperatively. Group C showed the most opioid consumption within the first 24 hours and during the hospitalization, while no significant difference was found between group A and group B. No significant difference was found among the 3 groups including function evaluation and postoperative complications. ACB + IPACK block can improve early analgesia when compared with ACB. However, the small statistical benefit to the addition of IPACK block to ACB may be unlikely to be clinically significant. Further studies may focus on patient selection and how to prolong the effect of IPACK block.