A comparative study between the analgesic effect of adductor canal block with or without IPACK block after total knee arthroplasty

Abstract

Background & objectives: Ensuring adequate post-operative pain management, especially after orthopedic procedures, is a crucial component of patients' well-being. Following total knee arthroplasty (TKA), the degree of pain underscores the need for effective analgesic measures to alleviate the adverse effects of pain. Utilizing multimodal analgesia has been recognized as an ideal approach for managing acute pain following TKA. This approach encompasses various strategies, including preemptive analgesia, neuraxial blockade, peripheral nerve blocks, as well as narcotic and non-narcotic analgesics.

This prospective research compared the efficacy of the combination of IPACK (Interspace between Popliteal Artery and the Capsule of the Posterior Knee) block and Adductor Canal Block (ACB) for postoperative pain following TKA, with a particular focus on posterior knee pain. The study compared the effectiveness of this technique with opioid analgesics administered after spinal anesthesia alone or with ACB used independently.

Methodology: The research was a prospective, double-blinded, randomized controlled trial, comprising 60 patients undergoing knee surgeries. The patients were assigned into three groups at random: Group A received solely spinal anesthesia without any peripheral nerve blocks; Group B underwent ultrasound guided ACB after spinal anesthesia, and Group C was administered a blend of ACB and IPACK block under ultrasound guidance at the commencement of the surgery. Postoperatively, pain levels were evaluated using VAS scores. If the VAS score exceeded 4, 50 mg of intravenous pethidine was used as a primary rescue analgesic to lower the VAS score to below 3.

Results: Demographic data and preoperative hemodynamic parameters (heart rate and mean arterial blood pressure) were equivalent in both groups. Postoperatively, HR at 4, 8, 12 and 24 h and MAP at 12 and 24 h were significantly different (P < 0.001). Time to first rescue analgesia, total narcotics intake and VAS scores were significantly different at 4, 8, 12 and 24 h (P < 0.001).

Conclusion: In patients undergoing TKA, postoperative analgesia of combined ACB and IPACK was more effective than that of ACB block alone regarding hemodynamic changes, pain scores, doses of pethidine required for pain relief and postoperative mobilization.

Keywords: Adductor Canal Block; IPACK; Knee Arthroplasty; Knee Capsule; Nerve Block

Citation: Taha Abdelghaffar MR, Nemr MM, Mohamed Mabrouk MH, Elgendy HMA, Abdulmageed AM. A comparative study between the analgesic effect of adductor canal block with or without IPACK block after total knee arthroplasty. Anaesth. pain intensive care 2025;29(2):242-247. DOI: 10.35975/apic.v29i2.2710

Received: October 10, 2024; Reviewed: October 31, 2024; Accepted: December 28, 2024