Comparison between IPACK (infiltration between the popliteal artery and capsule of knee) with femoral nerve block and femoral nerve block alone for postoperative pain control in TKA
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Abstract
Background: Femoral nerve block is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain.
The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia.
OBJECTIVE To determine IPACK with femoral nerve block was superior to femoral nerve block alone when combined with postoperative multimodal analgesia regimen
Materials and methods: A prospective study was conducted from MAY 2019 to December 2019 in a total of 30 patients undergoing unilateral total knee arthroplasty. The initial 15 consecutive patients received Femoral nerve block + IPACK (Group 1, n = 15), and the subsequent 15 patients received Femoral nerve block alone (Group 2, n = 15). All patients were evaluated with Morphine consumption recorded at 0 h , 2 h, 4h,6 h ,12 h ,24 h after the surgery.Pain score (VAS) and adverse events were the secondary outcome measures assessed for superiority.The data was analyzed by using exact probability test , t -test and rank sum test.
Results: Twenty-eight patients were available for analysis (Group1=15, Group2=13). Mean total morphine consumption over 8 postoperative hour of Group 1 was significantly less than Group 2 (4.3 mg vs 9.3 mg , p=0.006). Similarly, Group 1 had significantly less ondansetron requirement (N=3 vs N=11). Howerver, Overall morphine consumption 24, 48 postoperative hour and VAS at all postoperative hour were not different between both groups.
Conclusion: IPACK combined with femoral nerve block is a promising technique that offers improved pain management in the immediate postoperative period for patients under going TKA.
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References
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