S R Sankineani1, A R C Reddy2, Krishna Kiran Eachempati3, Ajit Jangale1, A V Gurava Reddy1. 1. Department of Orthopaedics, Sunshine Hospital, P.G.Road, Secunderabad, Telangana, India. 2. Department of Anaesthesia, Mediciti Institute of Medical Sciences, Medchal, Hyderabad, India. sukeshrao.sankineni@gmail.com. 3. Department of Orthopaedics, Maxcure Hospital, Madhapur, Hyderabad, Telangana, India.
Abstract
BACKGROUND: Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves. MATERIALS AND METHODS: A prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty. The initial 60 consecutive patients received ACB + IPACK (Group 1, n = 60), and the subsequent 60 patients received ACB alone (Group 2, n = 60). All patients were evaluated with VAS score for pain recorded at 8 h, postoperative day (POD) 1 and POD 2 after the surgery. The secondary outcome measures assessed were the range of movement (ROM) and ambulation distance. RESULTS: VAS score showed significantly (p < 0.005) better values in ACB + IPACK group compared to the ACB group. The mean ROM of knee and ambulation distance also showed significantly better values in ACB + IPACK group compared to the ACB group. CONCLUSION: ACB + IPACK is a promising technique that offers improved pain management in the immediate postoperative period without affecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.
BACKGROUND: Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves. MATERIALS AND METHODS: A prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty. The initial 60 consecutive patients received ACB + IPACK (Group 1, n = 60), and the subsequent 60 patients received ACB alone (Group 2, n = 60). All patients were evaluated with VAS score for pain recorded at 8 h, postoperative day (POD) 1 and POD 2 after the surgery. The secondary outcome measures assessed were the range of movement (ROM) and ambulation distance. RESULTS: VAS score showed significantly (p < 0.005) better values in ACB + IPACK group compared to the ACB group. The mean ROM of knee and ambulation distance also showed significantly better values in ACB + IPACK group compared to the ACB group. CONCLUSION:ACB + IPACK is a promising technique that offers improved pain management in the immediate postoperative period without affecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.
Authors: Neil A Hanson; Cindy Jo Allen; Lucy S Hostetter; Ryan Nagy; Ryan E Derby; April E Slee; Alex Arslan; David B Auyong Journal: Anesth Analg Date: 2014-06 Impact factor: 5.108
Authors: Abdullah Sulieman Terkawi; Dimitris Mavridis; Daniel I Sessler; Megan S Nunemaker; Khaled S Doais; Rayan Sulieman Terkawi; Yazzed Sulieman Terkawi; Maria Petropoulou; Edward C Nemergut Journal: Anesthesiology Date: 2017-05 Impact factor: 7.892
Authors: Jessica T Wegener; Bas van Ooij; C Niek van Dijk; Markus W Hollmann; Benedikt Preckel; Markus F Stevens Journal: Reg Anesth Pain Med Date: 2011 Sep-Oct Impact factor: 6.288
Authors: David A Crawford; Joanne B Adams; Keith R Berend; Adolph V Lombardi Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-05-18 Impact factor: 4.342
Authors: Brandon Kandarian; Pier F Indelli; Sanjay Sinha; Oluwatobi O Hunter; Rachel R Wang; T Edward Kim; Alex Kou; Edward R Mariano Journal: Korean J Anesthesiol Date: 2019-02-19