Eric Albrecht1, Julien Wegrzyn2, Aleksandar Dabetic3, Kariem El-Boghdadly4. 1. Program Director of Regional Anaesthesia, Department of Anaesthesia, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland. Electronic address: eric.albrecht@chuv.ch. 2. Professor, Department of Orthopaedic, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland. 3. Resident, Department of Anaesthesia, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland. 4. Consultant, Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Honourary Senior Lecturer, King's College London, London, United Kingdom.
Abstract
STUDY OBJECTIVE: The novel infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to relieve posterior knee pain after knee surgery. The study objective is to determine whether iPACK provides analgesia after knee surgery when compared with a control group. DESIGN: Systematic review, meta-analysis and trial sequential analysis. SETTING: Operating room, postoperative recovery area and ward, up to 24 postoperative hours. PATIENTS: Patients scheduled for knee surgery under general or spinal anaesthesia. INTERVENTIONS: We searched five electronic databases for randomized controlled trials comparing iPACK with a control group. MEASUREMENTS: The primary outcome was rest pain score scores on a visual analogue scale (VAS) of 0-10 at 12 h postoperatively, analysed according to the nature of surgery (total knee arthroplasty vs. anterior cruciate ligament reconstruction) and the use of multimodal analgesia. Secondary outcomes included rest and dynamic pain scores, intravenous morphine-equivalent consumption at 2 h and 24 h, and functional outcomes including ambulation distance and range of motion at discharge. MAIN RESULTS: Six trials involving 687 patients were included, all of which received total knee arthroplasty only. When compared with a control group, iPACK significantly reduced rest pain scores at 12 h, with a mean difference (95% CI) of -1.0 (-1.5 to -0.5), I2 = 93%, p = 0.0003, without subgroup differences for postoperative multimodal analgesia (p = 0.15). Secondary pain outcomes were inconsistently improved with iPACK. Functional outcomes were either similar between groups or had clinically unimportant differences. The overall quality of evidence was moderate. CONCLUSIONS: There is moderate level evidence that iPACK might provide analgesia for posterior pain after total knee arthroplasty when compared with a control group at 12 h, but was not associated with any other meaningful benefits. Based on these results, there is currently limited evidence supporting the use of iPACK as a complement to adductor canal block for analgesia after total knee arthroplasty.
STUDY OBJECTIVE: The novel infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to relieve posterior knee pain after knee surgery. The study objective is to determine whether iPACK provides analgesia after knee surgery when compared with a control group. DESIGN: Systematic review, meta-analysis and trial sequential analysis. SETTING: Operating room, postoperative recovery area and ward, up to 24 postoperative hours. PATIENTS: Patients scheduled for knee surgery under general or spinal anaesthesia. INTERVENTIONS: We searched five electronic databases for randomized controlled trials comparing iPACK with a control group. MEASUREMENTS: The primary outcome was rest pain score scores on a visual analogue scale (VAS) of 0-10 at 12 h postoperatively, analysed according to the nature of surgery (total knee arthroplasty vs. anterior cruciate ligament reconstruction) and the use of multimodal analgesia. Secondary outcomes included rest and dynamic pain scores, intravenous morphine-equivalent consumption at 2 h and 24 h, and functional outcomes including ambulation distance and range of motion at discharge. MAIN RESULTS: Six trials involving 687 patients were included, all of which received total knee arthroplasty only. When compared with a control group, iPACK significantly reduced rest pain scores at 12 h, with a mean difference (95% CI) of -1.0 (-1.5 to -0.5), I2 = 93%, p = 0.0003, without subgroup differences for postoperative multimodal analgesia (p = 0.15). Secondary pain outcomes were inconsistently improved with iPACK. Functional outcomes were either similar between groups or had clinically unimportant differences. The overall quality of evidence was moderate. CONCLUSIONS: There is moderate level evidence that iPACK might provide analgesia for posterior pain after total knee arthroplasty when compared with a control group at 12 h, but was not associated with any other meaningful benefits. Based on these results, there is currently limited evidence supporting the use of iPACK as a complement to adductor canal block for analgesia after total knee arthroplasty.
Authors: Abdul Sattar Narejo; Fatima Abdulwahab; Mansoor Aqil; Abdullah T Alsubaie; Hassan Y Hazazy; Tariq Alzahrani; Abdulaziz Aljurayyan; Ahmed Thallaj Journal: Saudi Med J Date: 2021-10 Impact factor: 1.422