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

Kertkiatkachorn, Wannida; Kampitak, Wirinaree; Tanavalee, Aree; Ngarmukos, Srihatach

doi:10.1016/j.arth.2020.06.086

Cited by 51 publications

(73 citation statements)

References 25 publications

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“…The search strategy identified 2180 unique citations. After independent and duplicate screening by two authors (RSD and BL), eight RCTs 13,[25][26][27][28][29][30][31] were identified that fulfilled eligibility criteria. Collectively, these eight RCTs consisted of 777 patients (377 patients received the iPACK block; 400 patients in the control cohort received another modality of peripheral nerve blockade or PAI for knee analgesia).…”

Section: Search Resultsmentioning

confidence: 99%

“…Bias assessment for all included studies is summarized in Figure 2. All eight RCTs 13,[25][26][27][28][29][30][31] generally demonstrated a low risk of bias in random sequence generation and allocation concealment, blinding of outcome assessment, incomplete outcome data, and selective reporting. In terms of blinding of participants, some RCTs 13,25,26 displayed a high risk for bias because although they blinded all surgeons, recovery room and floor nurses, research assistants, statisticians, and patients, it was impossible to blind the anesthesiologist performing the ultrasound-guided iPACK block who may have participated in the study.…”

Section: Risk Of Bias and Quality Assessmentmentioning

confidence: 98%

“…Other sources of bias included no true control group without a posterior knee block, and unequal dose of local anesthetic between study arms. For the primary anesthetic, five studies 13,25,28,29,31 administered neuraxial anesthesia, two studies 26,27 either administered general anesthesia or neuraxial anesthesia per the discretion of the primary anesthesia team, and one study administered general anesthesia only. 30 All RCTs excluded patients who had a history of chronic pain or utilized preoperative opioids.…”

Section: Risk Of Bias and Quality Assessmentmentioning

confidence: 99%

“…30 All RCTs excluded patients who had a history of chronic pain or utilized preoperative opioids. 13,[25][26][27][28][29][30][31] Local and Regional Anesthesia 2021:14 https://doi.org/10.2147/LRA.S303827…”

Section: Risk Of Bias and Quality Assessmentmentioning

confidence: 99%

“…Local anesthetic dosing regimen for iPACK blocks varied widely with three different types of local anesthetic medications utilized in included studies (ropivacaine, bupivacaine, and levobupivacaine). Five studies 25,26,[29][30][31] included epinephrine in the local anesthetic solution for the iPACK block. The most common formulation for iPACK was 0.25% levobupivacaine with epinephrine.…”

mentioning

confidence: 99%

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Ultrasound-Guided 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

D’Souza¹,

Langford²,

Olsen³

et al. 2021

LRA

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Posterior knee pain after total knee arthroplasty (TKA) is common despite multimodal analgesia and regional anesthesia use. This review included randomized controlled trials (RCTs) comparing analgesic outcomes after inclusion of local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block versus pathways without iPACK. Electronic databases (MEDLINE, Cochrane Library, Web of Science, Scopus) were searched from inception to 10/11/2020. Eligible studies evaluated iPACK use on primary outcomes: opioid consumption and pain scores with movement. Secondary outcomes included rest pain, patient satisfaction, length of stay (LOS), gait distance, knee range of motion (ROM), and complications. Bias and quality were appraised using the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. Eight RCTs (777 patients) were included. iPACK block use demonstrated similar opioid consumption in the PACU (4/7 RCTs) and 24 hours after TKA (5/7 RCTs) compared to without iPACK (moderate-quality GRADE evidence). Additionally, iPACK block use demonstrated lower movement pain scores in PACU (3/5 RCTs) but similar or higher pain scores after 24 hours (5/7 RCTs; lowquality GRADE evidence). Studies consistently reported no difference in gait distance (4/4 RCTs) or complications (7/7 RCTs) between treatment arms (high-quality GRADE evidence), although differing effect estimates were observed with resting pain, satisfaction, LOS, and knee ROM. This review provides a foundation of knowledge on iPACK efficacy. While evidence does not currently support widespread inclusion of iPACK within enhanced recovery pathways for TKA, limitations suggest further study is warranted.

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Section: Search Resultsmentioning

confidence: 99%

Section: Risk Of Bias and Quality Assessmentmentioning

confidence: 98%

Section: Risk Of Bias and Quality Assessmentmentioning

confidence: 99%

Section: Risk Of Bias and Quality Assessmentmentioning

confidence: 99%

mentioning

confidence: 99%

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Ultrasound-Guided 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

D’Souza¹,

Langford²,

Olsen³

et al. 2021

LRA

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iPACK Block: Infiltration in the Interspace Between Popliteal Artery and Capsule of the Knee

Jack

Gomez²,

Chan

2022

Regional Nerve Blocks in Anesthesia and Pain Therapy

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Clinical effects of interspace between the popliteal artery and capsule of the posterior knee block with multimodal analgesia for total knee arthroplasty: a systematic review and meta-analysis

Qiao

Feng

Zhang

et al. 2023

Arch Orthop Trauma Surg

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Purpose Combination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation. Interspace between the popliteal artery and the capsule of the posterior knee block (IPACK) has been introduced clinically. We evaluated the efficacy of IPACK in combination with other nerve blocks after total knee arthroplasty. Methods Data were obtained from PubMed, Cochrane Library, Web of Science, and Sciencedirect. Studies that compared outcomes using IPACK combined with other regional nerve blocks after total knee arthroplasty with other analgesic modalities and those which used pain scores or opioid consumption as primary or secondary outcomes were included. Results Seventeen articles (20 trials, 1652 patients) were included. IPACK supplementation significantly reduced rest pain scores after total knee arthroplasty at postoperative hours 8–12(95%CI − 0.85 [− 1.36, − 0.34], I2 = 94%, p = 0.001), postoperative day 1 (95% CI − 0.49 [− 0.85, − 0.14], I2 = 87%, p = 0.006), and postoperative day 2 (95% CI − 0.28 [− 0.51, -0.05], I2 = 72%, p = 0.02); there was no significant difference at postoperative day 3 or discharge (95% CI − 0.14 [− 0.33, 0.05], I2 = 0%, p = 0.14). Combination treatment resulted in reduced dynamic pain scores at postoperative hours 8–12 (95%CI − 0.52 [− 0.92, − 0.12], I2 = 86%, p = 0.01) and postoperative day 1(95% CI − 0.49 [− 0.87, − 0.11], I2 = 88%, p = 0.01). There was no difference between postoperative day 2(95% CI − 0.29 [− 0.63, 0.05], I2 = 80%, p = 0.09), postoperative day 3 or discharge (95% CI − 0.45 [− 0.92, 0.02], I2 = 83%, p = 0.06). In addition, it strongly reduced postoperative opioid consumption within 24 H (95% CI − 0.76 [− 1.13, − 0.39], I2 = 85%, p < 0.00001), 24–48 H (95% CI − 0.43 [− 0.85, − 0.01], I2 = 83%, p = 0.04), and total opioid use (95% CI − 0.64 [− 1.07, − 0.22], I2 = 86%, p = 0.003). Although IPACK supplementation improved timed up and go test and walking distance at postoperative day 2, there was no statistically significant difference at other time periods or obvious improvement in knee range of motion and quadriceps strength. IPACK block supplementation could shorten the length of stay (LOS) (95% CI − 0.40 [− 0.64, − 0.15], I2 = 70%, p = 0.001) and improve patient satisfaction (95% CI 0.43 [0.01, 0.84], I2 = 87%, p = 0.04). Conclusion Based on these results, IPACK supplementation, in addition to standard postoperative analgesia, can be used effectively and safely to relieve early postoperative pain after total knee arthroplasty.

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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

Cited by 51 publications

References 25 publications

Ultrasound-Guided 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

Ultrasound-Guided 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

iPACK Block: Infiltration in the Interspace Between Popliteal Artery and Capsule of the Knee

Clinical effects of interspace between the popliteal artery and capsule of the posterior knee block with multimodal analgesia for total knee arthroplasty: a systematic review and meta-analysis

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