Community hospital implementation of the IPACK block reduces opioid use and length of stay after total knee arthroplasty

VanderWielen, Beth; Fitzsimmons, Alec; Kovács, Attila; Topolski, Mark S.

doi:10.1016/j.jclinane.2020.109857

Cited by 6 publications

(11 citation statements)

References 3 publications

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“…[12] Several previous studies have investigated the analgesic efficacy of adding an IPACK block to multimodal analgesia protocol for patients undergoing TKR. [11,13,14,15] However, the results of our meta-analysis are not in line with those of previous cohort studies. Sankineani et al compared ACB alone with ACB+IPACK and found that ACB+IPACK group had lower pain scores within 48 hours after surgery as well as significantly better range of motion and ambulatory distance when compared with ACB group.…”

Section: Discussioncontrasting

confidence: 99%

“…Several previous studies have investigated the analgesic efficacy of adding an IPACK block to multimodal analgesia protocol for patients undergoing TKR [11,13,14,15] . However, the results of our meta-analysis are not in line with those of previous cohort studies.…”

Section: Discussioncontrasting

confidence: 87%

“…A retrospective study by Biehl et al showed that addition of the IPACK block to the ACB or FNB contributed to marginally lower mean pain scores in patients at postoperative 12 hours; however, the analgesic benefit of the IPACK block was diminished at postoperative 24 hours and 48 hours, which was consistent with our conclusion [14] . An another retrospective study by VanderWielen et al compared ACB+LIA alone with ACB+LIA+IPACK and showed clinically significant reduction in total postoperative opioid use in ACB+LIA+IPACK group, which was completely different from our results [15] . In our meta-analysis, we could not reveal the analgesic advantage of combination therapy over single therapy after 24 hours and total opioid consumption was similar in 2 groups.…”

Section: Discussionsupporting

confidence: 73%

“…[ 14 ] An another retrospective study by VanderWielen et al compared ACB+LIA alone with ACB+LIA+IPACK and showed clinically significant reduction in total postoperative opioid use in ACB+LIA+IPACK group, which was completely different from our results. [ 15 ] In our meta-analysis, we could not reveal the analgesic advantage of combination therapy over single therapy after 24 hours and total opioid consumption was similar in 2 groups.…”

Section: Discussionmentioning

confidence: 74%

“…After the title and abstract selection, 18 articles remained eligible for full-text screening. One prospective non-randomized study [13] and 3 retrospective studies [11,14,15] were excluded, all of which assessed the effect of additional IPACK block on TKR. Finally, 5 RCTs were deemed eligible for inclusion based on pre-determined inclusion criteria [12,16–19] …”

Section: Resultsmentioning

confidence: 99%

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Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement

Wang¹,

Ma²,

Huang³

2021

Medicine

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Background: Currently, no meta-analysis exists elucidate the analgesic effect of adding IPACK block to our current multimodal analgesia regimen after total knee replacement (TKR). The purpose of this study is to systematically review the level I evidence in the literature to ascertain whether IPACK block can bring additional analgesic benefits to existing multimodal analgesia regimens. Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Only level I randomized controlled trials (RCTs) were included in our study. The primary outcome was the pain scores with rest and activity. Secondary outcomes included cumulative opioid consumption, cumulative distance ambulated, and length of stay (LOS). Results: Five RCTs with a total of 467 patients were included. The most important finding in our study was that although IPACK block supplementation improved pain scores at 12 hours with rest or activity after surgery, no such benefit was observed at subsequent time points during the postoperative period. Interestingly, IPACK supplementation did not reduce opioid consumption, especially in the first 24 hours after surgery. Furthermore, other postoperative outcomes, including cumulative distance ambulated and LOS, were also not improved by the addition of an IPACK. Conclusions: The addition of an IPACK block to multimodal analgesia regiments does not reduce the postoperative opioid consumption nor improve functional performance. However, it may be an appropriate method to improve immediate analgesic effects after TKR.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 87%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 74%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement

Wang¹,

Ma²,

Huang³

2021

Medicine

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Does the Addition of iPACK Block to Adductor Canal Block Provide Improved Analgesic Effect in Total Knee Arthroplasty? A Systematic Review and Meta-Analysis

et al. 2021

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The interspace between popliteal artery and the capsule of posterior knee (iPACK) block was proposed in recent years to relieve posterior knee pain. Since adductor canal block (ACB) and iPACK involve different branches of the sensory nerves, it is theoretically feasible to combine iPACK block and ACB to relief pain after total knee arthroplasty (TKA). We aim to validate the efficacy of adding iPACK block to ACB in the setting of a multimodal pain management protocol following TKA. A comprehensive literature review on Web of Science, Embase, the Cochrane Library, and PubMed was performed. Eight studies (N = 1,056) that compared the efficacy of iPACK block + ACB with ACB alone were included. Primary outcomes consisted of Visual Analogue Scale (VAS) score at rest or during activity at various time points. Secondary outcomes include opioids consumption, walking distance, and length of hospital stay (LOS). Compared to ACB alone, VAS scores at rest (standardized mean difference [SMD]: –1.18; 95% confidence interval [CI]: –2.05 to –0.30) and during activity (SMD: –0.26; 95% CI: –0.49 to –0.03) on the day of surgery were lower in the iPACK block + ACB group. However, the difference did not reach the minimal clinically important difference. Opioids consumption at postoperative 24 hours was lower in the iPACK + ACB group (SMD: –0.295; 95% CI: –0.543 to –0.048). VAS score on postoperative day (POD) 1 and POD2, opioids consumption from 24 to 48 hours, walking distance, and LOS were not different. In conclusion, the addition of iPACK block to ACB in a multimodal pain management protocol can effectively reduce opioids consumption in the early postoperative period. This is a level III, meta-analysis study.

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Fascial plane blocks: a narrative review of the literature

Kim

Liu

et al. 2021

Reg Anesth Pain Med

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Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As ‘new’ FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.

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Community hospital implementation of the IPACK block reduces opioid use and length of stay after total knee arthroplasty

Cited by 6 publications

References 3 publications

Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement

Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement

Does the Addition of iPACK Block to Adductor Canal Block Provide Improved Analgesic Effect in Total Knee Arthroplasty? A Systematic Review and Meta-Analysis

Fascial plane blocks: a narrative review of the literature

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