Evaluation of preemptive interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block for ostoperative pain management in arthroscopic knee surgeries: a retrospective study

Year 2022, Volume: 5 Issue: 3, 750 - 754, 30.05.2022

Murat Alparslan , Zeynep Nur Akçaboy , Gülçin Aydın , Işın Gençay , Kevser Peker , Birhan Oktaş , Ahmet Tuğrul Şahin

https://doi.org/10.32322/jhsm.1088635

Abstract

Background: Interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block is block, which is done by infiltration of local anesthetic to block terminal branches of genicular nerves and popliteal plexus that innervate the posterior capsule of the knee joint. In this study, we retrospectively reviewed our patient’s data to which IPACK block was applied for arthroscopic knee surgery. Our aim was to evaluate the effectiveness of IPACK block on postoperative analgesia, effects on additional analgesic consumption and patient satisfaction.
Material and Method: The data of 60 patients who underwent arthroscopic knee surgery under spinal anesthesia with or without applied preemptive IPACK block for postoperative analgesia were collected between October 2019 and December 2020. Group I consisted of 30 patients with preemptive IPACK block, while 30 patients without block were classified as the control group (Group II). Postoperative 0-1-2-6-12 and 24th hour VAS scores, additional analgesic needs, patient satisfaction scores, were compared in groups as primary outcome.
Results: As a result of the comparison between the groups, it was seen that there was a significant difference between the groups in favor of the IPACK Block group in terms of postoperative VAS scores after 1st hour, postoperative analgesic needs and patient satisfaction (p<0.001).
Conclusion: Preemptive IPACK block, performed in patients who will undergo arthroscopic knee surgery, reduces the patient's pain in the postoperative period, shortens the length of hospital stay, positively affects patient comfort and increases patient satisfaction considerably. We believe that IPACK block alone or in addition to other blocks or methods will be effective in preventing arthroscopic knee surgery pain and it will be useful to conduct new studies with more patients.

Keywords

Interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block, artroscopic knee surgery, preemptive, analgesia, peripheric block

References

• O’Donnell BD, Iohom G. Regional anesthesia techniques for ambulatory orthopedic surgery. Curr Opin Anaesthesiol 2008; 21: 723-8.
• Buckenmaier CC. Anaesthesia for outpatient knee surgery. Best Pract Res Clin Anaesthesiol 2002; 16: 255-70.
• Lamplot JD, Wagner ER, Manning DW. Multimodal pain managementin total knee artroplasty. J Arthroplasty 20014; 29: 329-34.
• Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee artroplasty. Curry Pain Headache Rep 2017; 21: 23.
• Manickam B, Perlas A, Duggan E, Brull R, Chan VW, Ramlogan R. Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med 2009; 34: 578-80.
• Niesen AD, Harris DJ, Johnson CS, et al. Interspace between popliteal artery and posterior capsule of the knee (IPACK) injected spread: a cadaver study. J Ultrasound Med 2019; 38: 741-5.
• Tran J, Giron Arango L, Peng P, Sinha SK, Agur A, Chan V. Evaluation of the IPACK block injectate spread: a cadaveric study. Reg Anesth Pain Me 2019; 44: 689-94.
• Elliot CE, Thobhani S. The adductor canal catheter and interspace between the popliteal artery and the posterior capsule of the knee for total knee arthroplasty. Reg Anesth Pain Med 2014; 18: 126-9.
• Voutilainen A, Pitkäaho T, Kvist T, Vehviläinen-Julkunen K. How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. J Advanc Nurs 2016; 72: 946-57.
• Woolf CJ, Chong MS. Preemptive analgesia- treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362-79.
• Terkawi AS, Mavridis D, Sessler DI, et al. Pain management modalities after total knee arthroplasty: a network meta-analysis of 170 randomized controlled trials. Anesthesiology 2016; 126: 923-37.
• Moucha CS, Weiser MC, Levin EJ. Current strategies in anesthesia and analgesia for total knee artroplasty. J Am Acad Orthop Surg 2016; 24: 60-73.
• Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee artroplasty: a randomized, blinded study. Reg Anesth Pain Med 2015; 40: 3-10.
• Pham DC, Gautheron E, Guilley J, et al. The value of adding sciatic block to continous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med 2005; 30: 128-33.
• Hunt KJ, Bourne MH, Mariani EM. Single injection femoral and sciatic nerve blocks for pain control after knee arthroplasty. J Arthroplast 2009; 24: 533-8.
• Vora MU, Nicholas TA, Kassel CA, Grant SA. Adductor canal block for knee surgical procedures: review article. J Clin Anesth. 2016; 35: 295-303.
• Wegener JT, Dijk NV, Hollmann MW, Preckel B, Stevens MF. Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty: a prospective, randomized, controlled trial. Reg Anesth Pain Med 2011; 36: 481-8.
• Nader A, Kendall MC, Manning DW, et al. Single-dose adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia after total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med 2016; 41: 678-84.
• Sinha SK, Abrams JH, Arumugam S,et al. Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study. Anesth Analg. 2012; 115: 202-6.
• Yadeau JT, Goytizolo EA, Padgett DE, et al. Analgesia after total knee replacement: local infiltration versus epidural combined with a femoral nerve blockade; a prospective, randomized pragmatic trial. Bone Joint 2013; 95: 629-35.
• Vendittoli PA, Makinen P, Drolet P, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am 2006; 88: 282-9.
• Jeong MS, Song EK, Seon JK, Byun JW, Lee KJ, Jung YW. Effectiveness of pain relief for femoral nerve block in multimodal pain control protocols in total knee arthroplasty. J Korean Orthop Assoc 2011; 46: 237.
• Danelli G, Fanelli A, Ghishi D, et al. Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block. Anesthesia 2009; 64: 638-42.
• Amer N. Combined adductor canal and i-PAK blocks is better than combined adductor canal and periarticular injection blocks for painless ACL reconstruction surgery. J Anesth Crit Open Access. 2018; 10: 154-7.