![]() ![]() Continuous infusion of 0.125% levobupivacaine at a rate of 4 ml/h for femoral nerve block was started immediately after surgery and continued for 48 h. Patients in group I received IPACK block using 0.375% ropivacaine 20 ml. Twenty ml of 1.5% mepivacaine was injected for the subgluteal approach to SNB for patients in group S. A 25G catheter-over-needle was inserted for continuous FNB and 15 ml of 0.375% ropivacaine was injected. All the blocks were conducted under ultrasound guidance preoperatively. Group S included patients receiving SNB and group I included those receiving IPACK block. We extracted data of two groups of patients. Patients who received continuous SNB or spinal anesthesia were excluded from analysis. All patients received general anesthesia, continuous femoral nerve block and intra-articular local anesthetic injection. Patients who underwent unilateral TKA between May 2017 and December 2020 were identified. ![]() With IRB approval, we analyzed data saved in our regional anesthesia database and medical records. The present study retrospectively analyzed data saved in our institutional registry and medical records to evaluate the incidence rate of motor blockade after IPACK block and compared the motor blockade and analgesic effects between IPACK block and SNB in patients undergoing TKA. There is still limited information available on the incidence rate and severity of motor blockade after IPACK block and few studies have compared motor blockade after IPACK and sciatic nerve blocks. IPACK block has been described to have superiority over sciatic nerve block with motor-sparing effect, however recent studies and case reports have suggested that motor blockade of the sciatic nerve also occurs after IPACK block. Sciatic nerve block (SNB) and newly developed local anesthetic infiltration between the popliteal artery and capsule of the knee (IPACK) block can reduce pain on the posterior part. Femoral nerve block or adductor canal block have been used to control anterior knee pain. Total knee arthroplasty (TKA) causes severe postoperative pain, which requires a combination of peripheral nerve blocks for effective analgesia. Shimane University Hospital, Izumo, Japanĭisclosures: K. Kotaro Gunji, M.D., Shinichi Sakura, M.D., Yuki Aoyana, M.D., Yoshimi Nakaji, M.D., Yoji Saito, M.D. All rights reserved.Ipack Versus Sciatic Nerve Block: Effects On Motor Block And Analgesia After Total Knee Arthroplasty However, patients who received ACB + iPACK block may require higher amounts of opioids and have worse immediate functional performance.Īdductor canal block analgesia iPACK (interspace between the popliteal artery and capsule of the posterior knee) block periarticular injection total knee arthroplasty ultrasound-guidance.Ĭopyright © 2020 Elsevier Inc. 04, respectively) in the ACB + iPACK group.ĪCB with iPACK block provides a noninferior analgesia compared with PAI when combined with CACB. 05) and showed greater reduced quadriceps strength at 0 and 45 degrees on postoperative day 0 (P =. However, morphine requirement at 48 postoperative hours was significantly higher (P <. ![]() The mean visual analog scale pain scores were low and no clinically significant differences between groups. The upper limit of 95% confident interval was lower than the prespecified noninferiority limit. Pain scores, morphine consumption, functional performance, and adverse events were the secondary outcome measures assessed for superiority.Īdjusted mean differences, (ACB + iPACK) - (ACB + PAI), in anterior and posterior knee pain scores on movement at 12 postoperative hours were -0.66 (-1.86, 0.54) and -0.19 (-1.36, 0.99), respectively. Noninferiority was concluded for the primary outcome if the adjusted mean between-group difference in pain on movement at 12 postoperative hours was within 1.3 points on a visual analog pain scale. Seventy-six patients were randomized to receive either ACB + iPACK block and continuous ACB (CACB) (ACB + iPACK group) or PAI and CACB (ACB + PAI group). ![]() This study aimed to determine if ACB with iPACK block was noninferior to ACB with periarticular injection (PAI) when combined with postoperative multimodal analgesia regimen. The combination of adductor canal block (ACB) and infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block may provide sufficient motor-sparing anterior and posterior knee analgesia after total knee arthroplasty. ![]()
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