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.
Similar content being viewed by others
References
Mahoney OM, Noble PC, Davidson J et al (1990) The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty. Clin Orthop Relat Res 260:30–37
Paul JE, Arya A, Hurlburt L et al (2010) Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology 113(5):1144–1162
Lamplot JD, Wagner ER, Manning DW (2014) Multimodal pain management in total knee arthroplasty. J Arthroplasty 29(2):329–334
Korean Knee Society (2012) Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res 24(4):201–207
Li D, Ma GG (2016) Analgesic efficacy and quadriceps strength of adductor canal block versus femoral nerve block following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24(8):2614–2619
Soltesz S, Meiger D, Milles-Thieme S, Saxler G, Ziegeler S (2016) Intermittent versus continuous sciatic block combined with femoral block for patients undergoing knee arthroplasty. A randomized controlled trial. Int Orthop 40(9):1861–1867
Hanson NA, Allen CJ, Hostetter LS, Nagy R et al (2014) Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg 118(6):1370–1377
Li D, Yang Z, Xie X, Zhao J, Kang P (2016) Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop 40(5):925–933
Laoruengthana A, Rattanaprichavej P, Rasamimongkol S, Galassi M (2017) Anterior vs posterior periarticular multimodal drug injections: a randomized, controlled trial in simultaneous bilateral total knee arthroplasty. J Arthroplasty 32(7):2100–2104
Ilfeld BM, McCartney CJ (2017) Searching for the optimal pain management technique after knee arthroplasty: analgesia is just the tip of the iceberg. Anesthesiology 126(5):768–770
Sinha SK, Abrams JH, Arumugam S et al (2012) 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 115(1):202–206
Elliott CE, Myers TJ, Soberon JR, et al (2015) The adductor canal block combined with iPACK improves physical therapy performance and reduces hospital length of stay (Abstract 197). Presented at the 40th annual regional anesthesiology and acute pain medicine meeting (ASRA), 14–16 May in LasVegas, Nevada
Terkawi AS, Mavridis D, Sessler DI, Nunemaker MS et al (2017) Pain management modalities after total knee arthroplasty: a network meta-analysis of 170 randomized controlled trials. Anesthesiology 126(5):923–937
Vora MU, Nicholas TA, Kassel CA, Grant SA (2016) Adductor canal block for knee surgical procedures: review article. J Clin Anesth 35:295–303
Pham Dang C, Gautheron E, Guilley J et al (2005) The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med 30(2):128–133
Wegener JT, Dijk NV, Hollmann MW, Preckel B, Stevens MF (2011) 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 36(5):481–488
Nader A, Kendall MC, Manning DW et al (2016) 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 41(6):678–684
Cullom C, Weed JT (2017) Anesthetic and analgesic management for outpatient knee arthroplasty. Curr Pain Headache Rep 21(5):23
Safa B, Gollish J, Haslam L, McCartney CJ (2014) Comparing the effects of single shot sciatic nerve block versus posterior capsule local anesthetic infiltration on analgesia and functional outcome after total knee arthroplasty: a prospective, randomized, double- blinded, controlled trial. J Arthroplasty 29(6):1149–1153
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Sankineani, S.R., Reddy, A.R.C., Eachempati, K.K. et al. Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol 28, 1391–1395 (2018). https://doi.org/10.1007/s00590-018-2218-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-018-2218-7