Comparison of analgesic techniques: iPACK+PAI vs ACB+PAI in total knee arthroplasty: A single-center non-inferiority randomized controlled trial
Keywords:
Morphine consumption, IPACK block, adductor canal block, knee arthroplasty, postoperative painAbstract
Knee osteoarthritis stands as the predominant indication necessitating total knee arthroplasty (TKA), a procedure often accompanied by moderate to severe postoperative pain. Multimodal analgesia strategies for TKA encompass diverse pharmacological regimens and specific nerve blockades and aims to achieve optimal analgesia, facilitating early mobilization, and minimizing opioid consumption. The objective of the study is to compare cumulative morphine consumption in patients undergoing TKA between adjunct adductor canal block (ACB) and interspace between the popliteal artery and capsule of the knee (IPACK) block within the first 12 postoperative hours. In a non-inferiority, randomized controlled trial, this study assessed the efficacy of IPACK block or ACB combined with periarticular infiltration (PAI) in patients undergoing TKA under spinal block, focusing on postoperative morphine consumption. The patients were enrolled, and randomly assigned to either the ACB group or the IPACK group to attain a final 1:1 ratio with 14 patients in each group. The primary endpoint was the cumulative morphine consumption at 12 hours postoperatively. The mean morphine consumption in the IPACK group was 7.71±4.18 mg compared to 7.14±5.2 mg in the ACB group, yielding a mean difference = 0.57 mg (95% confidence interval = -3.23, 4.37). Cumulative morphine consumption at 60 minutes, 6 hours, and 24 hours did not exhibit statistical disparities between the groups. Similarly, pain scores and side effects at these time points did not demonstrate statistically significant differences. Nevertheless, the trial could not establish non-inferiority, possibly due to the small sample size. In conclusion, in the context of PAI accompanying TKA, the cumulative morphine consumption in IPACK block combined with PAI did not differ from that of ACB combined with PAI at the 12-hour mark postoperatively. There were also no differences observed in the pain score and associated side effects.
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