Efficacy of Adding an Interspace Block to the Posterior Knee for Perioperative Pain in Total Knee Arthroplasty: a Randomized Controlled Trial

Overview

Journal Acta Orthop

Specialty Orthopedics

Date 2022 Nov 30

PMID 36448721

Authors

Swist Chatmaitri

Suwimon Tangwiwat

Pathom Halilamien

Pakpoom Ruangsomboon

Chaturong Pornrattanamaneewong

Keerati Chareancholvanich

Rapeepat Narkbunnam

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: The interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block is a novel anesthetic technique for total knee arthroplasty (TKA). Our objective was to compare the effect of IPACK and adductor canal block (ACB) and periarticular injection (PAI), relative to ACB and PAI only, from baseline to postoperative day 3, in patients undergoing unilateral primary TKA.

Patients And Methods: This was a single-center, double-blinded, randomized controlled trial. Adults over the age of 50 who were scheduled for unilateral primary TKA were enrolled. They were randomly assigned to ACB and PAI block (control group), or ACB, PAI, and IPACK block (IPACK group). The primary outcome was mean pain at rest during 24-48 hours post-operation using a numerical rating scale (0-10). We also investigated opioid use and ambulation pain.

Results: 89 patients were evaluated, 45 from the control group and 44 from the IPACK group. Despite slightly higher mean pain score at rest in the control group, no statistically significant difference was found during 0-24 hours (0.13; 95% CI -0.19 to 0.46), 24-48 hours (0.42; CI -0.06 to 0.89), and 48-72 hours (0.35; CI 0.00 to 0.69) postoperatively as well as in maximum pain scores at rest. Neither pain during ambulation nor the number of opioids used differed between the trial groups at any given time point.

Conclusion: The addition of the IPACK block to ACB and PAI did not reduce postoperative pain intensity or opioid usage. Therefore, IPACK block may not offer any benefit for pain management in patients undergoing unilateral primary TKA who are already receiving ACB and PAI.

Citing Articles

Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia After Total Knee Arthroplasty: A Retrospective Cohort Study.

Zhao C, Wang Q, Cai L, Chen L, Kang P HSS J. 2025; 21(1):73-80.

PMID: 39846057 PMC: 11748369. DOI: 10.1177/15563316231201126.

Different peripheral nerve blocks for patients undergoing total knee arthroplasty: a network meta-analysis of randomized controlled trials.

Wang F, Wu J, Wu Y, Han X, Dai H, Chen Q Arch Orthop Trauma Surg. 2024; 144(9):4179-4206.

PMID: 39373765 PMC: 11564395. DOI: 10.1007/s00402-024-05507-y.

Does Adding an IPACK Block to the Suprainguinal Fascia Iliaca Block Improve the Quality of Analgesia in Patients Undergoing Knee Arthroplasty under Spinal Anesthesia? A Retrospective Cohort Study.

Kusderci H, Genc C, Canikli Adiguzel S, Guzel N, Tulgar S, Suren M Medicina (Kaunas). 2023; 59(10).

PMID: 37893588 PMC: 10608291. DOI: 10.3390/medicina59101870.

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