Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty

Sogbein, Olawale A; Sondekoppam, Rakesh V.; Bryant, Dianne; Johnston, David; Vasarhelyi, Edward M.; MacDonald, Steven J.; Lanting, Brent A.; Ganapathy, Sugantha; Howard, James L.

doi:10.2106/jbjs.16.01266

Cited by 46 publications

(45 citation statements)

References 89 publications

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“…Opioid consumption is considered an objective method of measuring pain. The tendency of lower efficacy with femoral and sciatic block may be due to the fact that some part of the knee is innervated by the other nerves such as the obturator nerve [33,34] and some cutaneous nerve [35] which are still not blocked. Thus, a peripheral nerve block may need supplementary treatment with more systemic analgesics such as opioids and NSAIDs [32].…”

Section: Discussionmentioning

confidence: 99%

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

et al. 2020

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Background: Total knee arthroplasty (TKA) is usually associated with moderate to severe postoperative pain. Peripheral nerve block (PNB) and local infiltration analgesia (LIA) are two major methods for postoperative analgesia. Femoral nerve block (FNB) leads to residual posterior knee pain; thus, currently sciatic nerve block (SNB) and LIA are two major options for supplementing FNB. However, the efficacy and safety of LIA compared with combined femoral and sciatic nerve block still remain controversial. Here, we conducted a study to analyze the postoperative analgesic efficacy of these two methods. Method: Two hundred six patients undergoing TKA were enrolled in a retrospective cohort study. The patients received either PNB or LIA. All patients in PNB group were conducted combined femoral and sciatic nerve block. All patients were encouraged to use patient-controlled analgesia (PCA) after surgery. The postoperative visual analog scale (VAS) at rest or with movement during the first 24 h and 48 h was recorded. We analyzed the VAS of 24 h, VAS of 48 h, opioid consumption, and adverse effects between PNB group and LIA group. Chi-square test and nonparametric test were used in this study. Results: There were 82 patients in the PNB group and 124 patients in the LIA group. The patients' characteristics such as age, height, weight, and ASA showed no significant difference (P > 0.05). No significant differences were found (P > 0.05) between the two groups regarding VAS score at rest or with movement. The LIA group had less opioid consumption than the PNB group but without significant difference (P > 0.05). In both groups, the most common side effect was nausea, and the side effects showed no significant differences between groups (P > 0.05). Conclusion: Local infiltration analgesia provided a similar analgesic effect and complications compared with combined femoral and sciatic nerve block in the short term. Considering less opioid consumption with local infiltration analgesia though without significant difference and its convenience, local infiltration analgesia provided better postoperative analgesia.

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Section: Discussionmentioning

confidence: 99%

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

et al. 2020

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“…Therefore, ACB has become a more popular analgesia technique in TKA and is more commonly used to control postoperative pain. However, recent studies have shown that ACB covers most of the anteromedial aspect of the knee joint, but does not provide the coverage of the lateral and posterior aspects of the knee . Consequently, extra measures, such as lateral femoral cutaneous nerve blocks or local infiltration analgesia, are recommended to combine with ACB to achieve the satisfactory outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies have shown that ACB covers most of the anteromedial aspect of the knee joint, but does not provide the coverage of the lateral and posterior aspects of the knee . Consequently, extra measures, such as lateral femoral cutaneous nerve blocks or local infiltration analgesia, are recommended to combine with ACB to achieve the satisfactory outcomes . In fact, some researchers even suggest that using periarticular or intra‐articular infiltration analgesia without nerve block could provide good postoperative pain relief results .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

et al. 2019

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Background Local injection of a multimodal cocktail including corticosteroid is commonly used for postoperative pain following total knee arthroplasty (TKA). However, it is inconclusive whether additional corticosteroid is beneficial. This meta‐analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy of an additional, local injection of corticosteroid in terms of pain relief and knee function recovery after TKA. Methods RCTs in electronic literature databases including PubMed, Web of Science, Embase, and Cochrane Library were systematically searched. Of 1,628 records identified, 9 RCTs involving 727 knees were eligible for data extraction and meta‐analysis. Results Local injection of a multimodal cocktail including corticosteroid did not contribute to pain relief within 12 hours postoperatively (P > 0.05). However, from 24 hours to 72 hours, it significantly decreased pain scores (P < 0.05, all) at rest and reduced total rescue opioid consumption postoperatively (P < 0.05). Knee range of motion (ROM) was improved at postoperative day 1 (POD1) and POD2 (P < 0.05), and hospital stay (P < 0.05) was shortened after local injection of corticosteroid. However, the other outcomes, including knee ROM after POD2, C‐reactive protein level, Knee Society score, postoperative nausea and vomiting, and wound complication occurrences, were not significantly different (P > 0.05, all). Conclusions Additional corticosteroid added to a multimodal cocktail improved postoperative pain, enhanced knee functional recovery, and shortened hospital stays following TKA, but local injection of corticosteroids had no effect on reducing nausea and vomiting based on our outcomes.

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“…The posterior knee capsule is innervated by the terminal branches, which ramify from the popliteal plexus mainly formed by the contribution of the tibial and posterior branch of the obturator nerves. “Motor-sparing” blockade that provides analgesia to the posterior aspect of the knee without losing foot strength has received growing interest 14–18. Such selective techniques include the interspace between the popliteal artery and capsule of the posterior knee (iPACK) block,18–20 the popliteal plexus block,16 and the sensory posterior articular nerve of the knee block 17.…”

Section: Introductionmentioning

confidence: 99%

Motor-sparing effect of iPACK (interspace between the popliteal artery and capsule of the posterior knee) block versus tibial nerve block after total knee arthroplasty: a randomized controlled trial

Kampitak

Tanavalee

Ngarmukos

et al. 2020

Reg Anesth Pain Med

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Background and objectiveAn ultrasound-guided anesthetic technique targeting the interspace between the popliteal artery and capsule of the posterior knee (iPACK) can provide posterior knee analgesia with preserved motor function after total knee arthroplasty (TKA). This study compared the peroneal nerve motor-sparing effects of iPACK block and tibial nerve block (TNB) when combined with local infiltration analgesia (LIA) and continuous adductor canal block (CACB).MethodsIn this study, 105 patients scheduled for elective TKA were randomized to receive proximal iPACK block (iPACK1), distal iPACK block (iPACK2), or TNB, along with spinal anesthesia, modified LIA, and CACB. The primary outcome was the incidence of common peroneal nerve (CPN) motor blockade. Secondary outcomes included CPN sensory function, tibial sensorimotor function, posterior knee pain, pain score, intravenous morphine requirement, timed up-and-go test, quadriceps muscle strength, range of motion, length of hospital stay, patient satisfaction, and adverse events.ResultsThe incidence of CPN motor blockade was significantly higher in the TNB group than in the iPACK1 (p=0.001) and iPACK2 (p=0.001) groups, but was not significant between the iPACK1 and iPACK2 groups (p=0.76). Tibial nerve motor function was more preserved in the iPACK1 and iPACK2 groups than in the TNB group (p<0.001 and p<0.001, respectively). Complete CPN and tibial sensorimotor blockade were not observed in the iPACK2 group. Posterior knee pain score was significantly higher in the iPACK1 group than in other groups during the 24-hour postoperative period (p=0.001).ConclusionsCompared with TNB, iPACK1 and iPACK2 preserved CPN and tibial nerve motor function to a greater extent. However, iPACK2 did not demonstrate complete CPN and tibial nerve motor blockade while maintaining effective posterior knee pain relief.Trial registration numberTCTR20180206002.

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Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 46 publications

References 89 publications

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

Comparison between local infiltration analgesia with combined femoral and sciatic nerve block for pain management after total knee arthroplasty

Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Motor-sparing effect of iPACK (interspace between the popliteal artery and capsule of the posterior knee) block versus tibial nerve block after total knee arthroplasty: a randomized controlled trial

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