A randomized clinical trial of addition of IPACK block or selective tibial nerve block to adductor canal block for postoperative pain management after total knee arthroplasty | [Anaesthesia, Pain and Intensive Care • 2023]

Author(s):

1. Marwa Ahmed Abogabal: Department of Anesthesiology, Surgical Intensive Care & Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.

2. Shaimaa Waheed Zahra: Department of Anesthesiology, Surgical Intensive Care & Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.

3. Wafaa Mohamed Abdel- Elsalam: Department of Anesthesiology, Surgical Intensive Care & Pain Medicine, Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt.

4. Wafaa Madhy Abdelwahed: Department of Anesthesiology, Surgical Intensive Care & Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.

Abstract:

Background & Objective: Postoperative pain after total knee arthroplasty (TKA) is a significant factor influencing the surgical outcome. Adductor canal block (ACB) has no analgesic effect on the posterior knee capsule, which is innervated by the terminal branches of the tibial nerve and the posterior branch of the obturator nerve. We compared ACB plus IPACK block (infiltration of the interspace between the popliteal artery and the posterior capsule of the knee) versus ACB with selective tibial nerve block (TNB) for pain management after TKA. Methodology: We enrolled 70 patients, aged 40-80 y, body mass index of 18.5-35 kg/m2, scheduled for TKA in the study. Patients were randomly allocated to one of the two equal groups; Group 1 to receive ACB with IPACK block and Group 2 to receive ACB with TNB. Duration of sensory block, motor block, time to first rescue analgesic request, time to ambulation, and hospital length were noted in both groups. The 0-10 numeric rating scale (NRS) was used to measure the pain intensity in the patients. Results: Duration of sensory block, motor block, time to first rescue analgesic request, time to ambulation, and hospital length were significantly increased in Group 2 than in Group 1 (P < 0.001). The numeric rating scale was significantly lower in Group 2 at 8 h only but was comparable in other measurements. Range of motion and the strength of quadriceps were comparable between both groups at 24, 48, and 72 h postoperatively. Conclusions: Adductor canal block with IPACK preserved motor function better and reduced the time to ambulation and hospital stay compared to tibial nerve block with adductor canal block. However, adductor canal block with selective tibial nerve block prolongs sensory block, the time to first analgesia request, and reduces postoperative opioid consumption at first 24 h. Both methods had a comparable effect on quadriceps strength. Abbreviations: ACB - Adductor Canal Block; IPACK - Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee; TNB - Tibial Nerve Block; TKA - Total Knee Arthroplasty

Page(s): 567-574

DOI: 10.35975/apic.v27i5.2313

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 27, Issue: 5, Year: 2023

Keywords:

Total knee arthroplasty , Adductor canal block , Selective Tibial Nerve Block , IPACK

References:

[1] .2017 .. , 13 : 207-10.

[2] Small C,Laycock H C .2020 .Acute postoperative pain management. Br J Surg, 107 : 70-80.

[3] Lee B,Park SJ,Park KK,Kim HJ,Lee YS,Choi YS .2022 .Optimal location for continuous catheter analgesia among the femoral triangle, proximal, or distal adductor canal after total knee arthroplasty: a randomized double-blind controlled trial. -103284, 47 : 353-8.

[4] .2020 .Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty. J Orthop Surg Res, 15 : 41.

[5] Anesth J Clin .2021 .. , 71 : 110257.

[6] Ma HH,Chou TA,Tsai SW,Chen CF,Wu PK,Chen WM .2020 .The efficacy of continuous versus single-injection femoral nerve block in Total knee Arthroplasty: a systematic review and metaanalysis. BMC Musculoskelet Disord, 21 : 121.

[7] Li D,Alqwbani M,Wang Q,Liao R,Yang J,Kang P .2020 .Efficacy of adductor canal block combined with additional analgesic methods for postoperative analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled study. J Arthroplasty, 06 : 3554-62.

[8] Eur J Orthop Surg Traumatol .2018 .. , 28 : 667-75.

[9] .2021 .. , 21 : 282.

[10] Benimeli-Fenollar M,Montiel-Company JM,Almerich-Silla JM,Cibrián R,Macián-Romero C . .Tibial nerve block: Supramalleolar or retromalleolar approach? A randomized trial in 110. , : .

[11] Prasad GK .2020 .Postoperative analgesia techniques after total knee arthroplasty: a narrative review. Saudi J Anaesth, 494 : 19-90.

[12] Ochroch J,Qi V,Badiola I,Grosh T,Cai L,Graff V .2020 .Analgesic efficacy of adding the IPACK block to a multimodal analgesia protocol for primary total knee arthroplasty. -101558, 45 : 799-804.

[13] Albrecht E,Wegrzyn J,Dabetic A,El-Boghdadly K. .2021 .The analgesic efficacy of iPACK after knee surgery: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth, 72 : 110305.

[14] Kertkiatkachorn W,Kampitak W,Tanavalee A,Ngarmukos S. .2020 .Adductor canal block combined with ipack (interspace between the popliteal artery and the capsule of the posterior knee) block vs periarticular injection for analgesia after total knee arthroplasty: A randomized noninferiority trial. J Arthroplasty, 06 : 122-9.

[15] Tan Z,Kang P,Pei F,Shen B,Zhou Z,Yang J. .2018 .A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage. Medicine, 97(48) : e13391.

[16] Kampitak W,Tanavalee A,Ngarmukos S,Tantavisut S. .2020 .Motorsparing effect of iPACK (interspace between the popliteal artery and capsule of the posterior knee) block versus tibial nerve block after total knee arthroplasty: a randomized controlled trial. -100895, 45 : 267-76.

[17] Zheng FY,Liu YB,Huang H,Xu S,Ma XJ,Liu YZ .2021 .The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty. Braz J Anesthesiol, 04 : 110-4.

[18] Niesen AD,Harris DJ,Johnson CS,Stoike DE,Smith HM,Jacob AK .2019 .Interspace between popliteal artery and posterior capsule of the knee (IPACK) injectate spread: a cadaver study. J Med Ultrasound, 38 : 741-5.

[19] Abdallah FW,Madjdpour C,Brull R .2016 .Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A meta-analysis. Can J Anaesth, 63 : 552-68.

[20] Netravathi M,Taly AB,Sinha S,Bindu PS .2010 .Accidental spinal cord injury during spinal anesthesia: A report. Ann Indian Acad Neurol, 13 : 74200-2327.

[21] Guyton GP,Mann RA .2000 .The pathogenesis and surgical management of foot deformity in Charcot-Marie-Tooth disease. Foot Ankle Clin, 5 : 317-26.

[22] Thobhani S,Scalercio L,Elliott CE,Nossaman BD,Thomas LC,Yuratich D .2017 .Novel regional techniques for total knee arthroplasty promote reduced hospital length of stay: An analysis of 106 patients. , 17 : 233-8.

[23] Patterson ME,Vitter J,Bland K,Nossaman BD,Thomas LC,Chimento GF .2020 .The effect of the IPACK block on pain after primary TKA: A double-blinded, prospective, randomized trial. J Arthroplasty, 01 : S173-7.

[24] D'Souza RS,Langford BJ,Olsen DA,Johnson RL .2021 .UltrasoundGuided 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. Local Reg Anesth, 14 : 85-98.

[25] Sinha SK,Abrams JH,Arumugam S,D'Alessio J,Freitas DG,Barnett JT .2012 .Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study. Anesth Analg, 115 : 202-6.

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