Ambulatory knee replacements with IPACK block

Jinadu, Samiat; Pai, Poonam; Lai, Yan H.

doi:10.1016/j.jclinane.2019.08.021

Cited by 10 publications

(7 citation statements)

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“…The IPACK block is a novel regional technique developed to provide analgesia to this area without compromising motor function [3]. The IPACK, combined with an adductor canal block (ACB), involves solely blocking the sensory nerves of the anterior, medial, and posterior knee, preserving motor function to encourage early ambulation and expedited rehabilitation [4,5].…”

mentioning

confidence: 99%

Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty

Herman¹,

Urits²,

Eskander³

et al. 2020

Cureus

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Total knee arthroplasty (TKA) is among the most commonly performed orthopedic procedures. Controlling the pain of this patient population is essential in improving outcomes such as opioid consumption, hospital length of stay, overall function, and rehabilitation participation following their procedure. Local anesthetic infiltration of the interspace between the popliteal artery and capsule of the posterior knee, known as the IPACK block, combined with an adductor canal block (ACB) can be used to reduce pain in the challenging area of the posterior knee after knee surgery without compromising motor function of the quadriceps muscles. One limiting factor to this combination of techniques is the duration of analgesia provided. This case series demonstrates the combination of dexmedetomidine and dexamethasone (Dex-Dex) as local anesthetic adjuvants to significantly prolong the analgesic duration of ACB (in addition to IPACK block) in three patients undergoing TKA. Preoperative ACB and IPACK blocks were performed for postoperative analgesia in three TKA patients. The anesthetic mixture was 10 cc 0.2% ropivacaine combined with 25 mcg of dexmedetomidine and 5-mg preservative-free dexamethasone for the ACB, and 0.2% ropivacaine combined with 5-mg preservative-free dexamethasone was utilized for the IPACK block. Two of the patients reported experiencing four days of analgesia and one patient reported five days of analgesia following the ACB + IPACK block. Two of the patients required no opioid analgesics postoperatively. An ACB utilizing 0.75% ropivacaine has been demonstrated to provide approximately 10.8 hours of analgesia. Our series demonstrates a significantly prolonged duration of analgesia from this injectate combination. Few studies have utilized the Dex-Dex combination. The combination, however, was previously proven to safely increase the analgesic duration of a caudal block prior to hypospadias surgeries in pediatrics. More studies are needed to understand a potential synergistic effect of Dex-Dex, which could have a substantial impact on postoperative analgesia for TKA patients.

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confidence: 99%

Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty

Herman¹,

Urits²,

Eskander³

et al. 2020

Cureus

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“…27 There have been promising studies and reports on the utility of the IPACK block for posterior knee pain. 28 Sankineani et al showed that ACB with IPACK block provided better pain scores, improved ambulatory distance, and increased ROM compared with ACB alone in TKA. 16 Kim et al concluded that adding an IPACK block to single-shot ACB and PAI showed reduced dynamic pain when compared with PAI alone in TKA.…”

Section: Discussionmentioning

confidence: 99%

Integrating IPACK (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) Block in an Enhanced Recovery after Surgery Pathway for Total Knee Arthroplasty—A Prospective Triple-Blinded Randomized Controlled Trial

Jinadu

Okunlola

et al. 2022

J Knee Surg

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We explored the efficacy of an interspace between the popliteal artery and capsule of the posterior knee (IPACK) block when added to an established enhanced recovery after surgery (ERAS) pathway to assist with posterior knee analgesia and functional mobility after total knee arthroplasty (TKA). We recruited participants undergoing TKA in our prospective, randomized, triple-blinded controlled trial. All study patients participated in our ERAS pathway consisting of a primary spinal anesthetic, adductor canal nerve catheter, and periarticular joint infiltration. Patients were randomized to receive an IPACK block or no block. The primary outcome was total postoperative opioid consumption. Secondary outcomes included pain scores, recovery unit length of stay, time to first opioid use, the incidence of posterior knee pain, ambulation distance and activities of daily living on postoperative day 1, and hospital length of stay. A total of 96 patients were randomized to the control and IPACK groups. There were no statistical differences in primary or majority of secondary outcomes. There was a lower incidence of posterior knee pain (39%) in the IPACK group when compared with controls (8.7%), p < 0.01. In terms of opioid consumption and a majority of functional outcomes, our study demonstrates no overall benefits of adding an IPACK block in this ERAS pathway in TKA. Nevertheless, IPACK may have the potential of mitigating posterior knee pain after TKA. Level of evidence: level 1.Clinical trial number and registry URL: NCT03653416. www.clinicaltrials.gov.

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“…To effectively relieve pain in the posterior knee capsule, it targets the medial and lateral superior genicular nerves [55]. By guaranteeing coverage of both the anteromedial and posterior joints, the iPACK block and ACB together give a wider distribution of anesthetic coverage [55,56].…”

Section: Ipack Blockmentioning

confidence: 99%

“…According to recent research, the iPACK block, when combined with the adductor canal block and periarticular injection for TKA, significantly reduced postoperative pain during rest and ambulation [56,57]. Early hospital discharge, a reduction in the need for opioids, and quicker ambulation were the outcomes.…”

Section: Ipack Blockmentioning

confidence: 99%

Postoperative Pain in Orthopedics

Trinidad Castillo García,

Estela Elizabeth Ortega Ponce,

Carolina Martínez Esparza

2023

Topics in Postoperative Pain

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Most patients who undergo orthopedic surgery experience moderate-to-severe discomfort. Historically, opioids have been the primary medication class used to treat pain transmission pathways. In orthopedic practice, multimodal analgesia has become the predominant method of pain management. Utilizing multiple medications to treat post-surgical pain reduces the need for narcotics and accelerates the healing process. By introducing effective analgesic treatments and interventions, this procedure reduces the use of perioperative opioids and, over time, the risk of opioid toxicity and addiction. Previous research has demonstrated that multimodal analgesia reduces the use of analgesics in the early postoperative period for orthopedic procedures. Numerous substances can stimulate or sensitize directly. When the peripheral nociceptors are damaged, direct damage to the nervous system results in pain. Preoperative, intraoperative, and postoperative symptoms are essential. The emphasis is on management regimes and the pathophysiology underlying the mechanism for postoperative discomfort. A concise description of the effects of painkillers is provided. containing information on specific conditions and average dosage substances are classified further. Both neuropathy and subjective pain should be treated. By focusing on multimodal analgesia, anesthesiologists can reduce pain more effectively. More advanced techniques are utilized for postoperative pain management after orthopedic surgery, thereby enhancing the patient’s short- and long-term outcomes.

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Ambulatory knee replacements with IPACK block

Cited by 10 publications

References 1 publication

Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty

Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty

Integrating IPACK (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) Block in an Enhanced Recovery after Surgery Pathway for Total Knee Arthroplasty—A Prospective Triple-Blinded Randomized Controlled Trial

Postoperative Pain in Orthopedics

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