Postoperative analgesic effectiveness of ultrasound guided combined femoral - sciatic nerve block versus combined adductor canal block – I PACK block in patients undergoing total knee arthroplasty: A double- blind randomized study

Hussien, Rania Maher; Ismaïl, Mohamed; Salah, Amir; El-Shaer, Ahmed; Abdellatif, Ayman A; Abdelrahman, Tamer Nabil

doi:10.1080/11101849.2023.2238530

Cited by 2 publications

(1 citation statement)

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“…Therefore, our findings suggest that the iPACK block may be an alternative to the more traditional nerve blocks, like the SNB, which frequently have a negative impact on functional recovery, and are no longer recommended for pain management following primary TKA. Our findings align with Hussien et al who compared the analgesic effectiveness of ultrasound-guided combined femoral and SNB versus ACB + iPACK block in patients undergoing TKA and concluded that there was less motor power impairment in the ACB-iPACK group within the first 24 hours postoperatively and no significant difference in visual analogue pain score between groups [17]. Another study conducted by Zheng et al reported higher quadriceps femoris muscle strength, lower modified Bromage scale, and higher walking distance scores in the ACB + iPACK group than in the femoral nerve block combined with the SNB group [18].…”

Section: Discussionsupporting

confidence: 90%

Comparative Efficacy of iPACK vs Popliteal Sciatic Nerve Block for Pain Management Following Total Knee Arthroplasty: A Retrospective Analysis

Teixeira,

Sousa,

Martins Pereira

et al. 2024

Cureus

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IntroductionTotal knee arthroplasty (TKA) is associated with severe acute postoperative pain. The use of tourniquets and drains (T/D) is common in TKA but may have an influence on postoperative pain and muscular strength. The infiltration of local anesthetic between the popliteal artery and capsule of the knee (iPACK block) is a motorsparing block that provides analgesia to the posterior aspect of the knee. However, evidence regarding its efficacy is scarce. This study aims to assess the effectiveness of iPACK block and the impact of T/D use on pain and muscular strength after TKA. Material and methodsA retrospective study was carried out including patients who underwent TKA from January 2020 to April 2023. Patients were allocated into groups according to the peripheral nerve block performed and T/D use. ResultsWe included 415 patients in this study. No differences were found in pain at rest or the need for rescue analgesia between patients who received an iPACK block or sciatic nerve block (SNB) with T/D applied. Patients who received a SNB reported lower pain scores on movement (p = 0.019), but with a higher prevalence of motor block (p < 0.001). Patients who underwent surgery without using T/D reported lower pain scores on movement (p = 0.021) and reduced need for rescue analgesia (p = 0.041). ConclusionThese findings indicate that iPACK block can facilitate early mobilization after TKA without significant impact on postoperative muscle strength. Furthermore, the use of a T/D may be a source of postoperative pain that could compromise early rehabilitation.

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Section: Discussionsupporting

confidence: 90%