Optimization of regional analgesia after total knee arthroplasty based on ipack-block

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Abstract

AIM: To study the efficacy and safety of a combination of the IPACK and the adductor canal blocks (ACB) and compare with the femoral nerve block after total knee arthroplasty (TKA).

MATERIALS AND METHODS: Double-blind, prospective, randomized, controlled trial with 101 patients. Three groups were distinguished, differing in the chosen method of regional anesthesia. Group 1 included patients with a combination of afferent canal block and IPACK block, group 2 included patients with femoral nerve block, and group 3 included patients with femoral nerve block and IPACK block. Pain at rest and during movement, the need for opioid analgesics in the postoperative period, and the possibility of early activation of patients after knee arthroplasty were assessed on a visual analog scale. The incidence of side effects associated with regional anesthesia was also noted.

RESULTS: The study showed that the combination of adductor canal blockade and IPACK blockade showed the best effectiveness of pain syndrome control. Patients were less likely to need narcotic analgesics, there was no development of motor block and, as a result, patients were more satisfied with anesthesia. The combination of blockades made it possible to accelerate the rehabilitation of patients in the postoperative period, due to a decrease in pain and the absence of a motor block.

CONCLUSIONS: The use of IPACK blockade in combination with adductor canal blockade provides effective analgesia and reduces the use of analgesics, as well as increases the patient's rehabilitation potential.

About the authors

Anna A. Ezhevskaya

Privolzhsky Research Medical University

Author for correspondence.
Email: annaezhe@yandex.ru
ORCID iD: 0000-0002-9286-4679
SPIN-code: 2371-2825

MD, Dr. Sci. (Med.), Professor

Russian Federation, 10/1, Minin and Pozharskiy square, Nizhny Novgorod, 603005, Russia

Eugenia A. Zhulina

Privolzhsky Research Medical University

Email: annaezhe@yandex.ru
ORCID iD: 0000-0001-8491-1044
SPIN-code: 5057-2374

anesthesiologist

Russian Federation, 10/1, Minin and Pozharskiy square, Nizhny Novgorod, 603005, Russia

Tatyana O. Andrianova

Privolzhsky Research Medical University

Email: annaezhe@yandex.ru
ORCID iD: 0000-0002-4302-9925
SPIN-code: 1353-2809

clinical resident

Russian Federation, 10/1, Minin and Pozharskiy square, Nizhny Novgorod, 603005, Russia

Anna Yu. Morunova

Privolzhsky Research Medical University

Email: annaezhe@yandex.ru
ORCID iD: 0000-0003-4624-840X
SPIN-code: 4563-8349

anesthesiologist

Russian Federation, 10/1, Minin and Pozharskiy square, Nizhny Novgorod, 603005, Russia

References

  1. Ovechkin AM, Politov ME, Panov N.V. Ostryi i khronicheskii posleoperatsionnyi bolevoi sindrom u patsientov, perenesshikh total’noe endoprotezirovanie sustavov nizhnikh konechnostei. Anesteziologiya i Reanimatologiya. 2017;62(3). (In Russ). doi: 10.18821/0201-7563-2017-62-3
  2. Chan EY, Fransen M, Parker DA, et al. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014(5):CD009941. doi: 10.1002/14651858.CD009941.pub2
  3. Angers M, Belzile EL, Vachon J, et al. Negative Influence of femoral nerve block on quadriceps strength recovery following total knee replacement: A prospective randomized trial. Orthop Traumatol Surg Res. 2019;105(4):633–637. doi: 10.1016/j.otsr.2019.03.002
  4. Koryachkin VA. Peripheral nerve blocks and ultrasound navigation. Regional Anesthesia and Acute Pain Management. 2020;14(1):4–5. (In Russ). doi: 10.17816/1993-6508-2020-14-1-4-5
  5. Dannana CS, Apsingi S, Ponnala VK, et al. Comparative study of the influence of adductor canal block plus multimodal periarticular infiltration versus combined adductor canal block, multimodal periarticular infiltration and intra-articular epidural catheter ropivacaine infiltration on pain relief after total knee arthroplasty: a prospective study. Musculoskelet Surg. 2020;104(2):201–206. doi: 10.1007/s12306-019-00613-2
  6. Morozov DV, Boronina IV, Ryabtseva AA. Effects of different analgesia methods on early mobilization after knee join replacements. Regional Anesthesia and Acute Pain Management. 2020;14(1):12–18. (In Russ). doi: 10.17816/1993-6508-2020-14-1-12-18
  7. Thobhani S, Scalercio L, Elliott CE, et al. Novel Regional Techniques for Total Knee Arthroplasty Promote Reduced Hospital Length of Stay: An Analysis of 106 Patients. Ochsner J. 2017;17(3):233–238. PMC5625980
  8. Kulkarni MM, Dadheech AN, Wakankar HM, et al. Randomized Prospective Comparative Study of Adductor Canal Block vs Periarticular Infiltration on Early Functional Outcome After Unilateral Total Knee Arthroplasty. J Arthroplasty. 2019;34(10):2360–2364. doi: 10.1016/j.arth.2019.05.049
  9. Karpetas GZ, Spyraki MK, Giakoumakis SI, et al. Multimodal analgesia protocol for pain management after total knee arthroplasty: comparison of three different regional analgesic techniques. J Musculoskelet Neuronal Interact. 2021;21(1):104–112. PMC8020020
  10. Tran J, Giron Arango L, Peng P, et al. Evaluation of the iPACK block injectate spread: a cadaveric study. Reg Anesth Pain Med. 2019. doi: 10.1136/rapm-2018-100355
  11. Barrington MJ, Uda Y. Did ultrasound fulfill the promise of safety in regional anesthesia? Curr Opin Anaesthesiol. 2018;31(5):649–655. doi: 10.1097/ACO.0000000000000638
  12. Kampitak W, Tanavalee A, Ngarmukos S, Tantavisut S. Motor-sparing effect of iPACK (interspace between the popliteal artery and capsule of the posterior knee) block versus tibial nerve block after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2020;45(4):267–276. doi: 10.1136/rapm-2019-100895
  13. Ovechkin АМ. Postoperative pain: the state of problem and current trends in postoperative analgesia. Regional anesthesia and acute pain management. 2015;9(2):29–39. (In Russ).
  14. Kandarian B, Indelli PF, Sinha S, et al. Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement. Korean J Anesthesiol. 2019;72(3):238–244. doi: 10.4097/kja.d.18.00346
  15. Morozov DV, Boronina IV, Ryabtseva АА, Nikulina TА. Analgesic Efficiency and Effect on Motor Function of the Lower Extremity of Block of Femoral Nerve or Adductor Canal Combined with Tibial Nerve Block after Total Knee Replacement. Messenger of Anesthesiology and Resuscitation. 2017;14(5):106–107. (In Russ). doi: 10.21292/2078-5658-2017-14-5-106-107
  16. Sankineani SR, Reddy ARC, Eachempati KK, 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. 2018;28(7):1391–1395. doi: 10.1007/s00590-018-2218-7

Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Modified method of iPACK block execution (the injection is carried out from the medial side and from below relative to the sensor, retreating 1–2 cm from top to bottom from the sensor)

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3. Fig. 2. Ultrasound image of the iPACK block execution (direction of the needle from top to bottom at an angle of 45 ° towards the condyle of the femur (BC), to the space located between the condyles of the BC and the popliteal artery (A), infiltration is performed in the direction of the needle movement, with the main injection of the solution between the popliteal artery and the condyles of the femur bones)

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4. Fig. 3. Dynamics of pain syndrome in groups at rest and during movement (a – pain at rest according to VAS 12 hours after the operation; b – pain at rest according to VAS 24 hours after the operation; c – pain syndrome during flexion of the knee joint according to VAS 12 hours after the operation; d – pain syndrome during flexion of the knee joint according to VAS 24 hours after surgery)

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5. Fig. 4. Comparison of the need for opioid analgesics (promedol) (1 – group IPACK+ACB, 2 – group with femoral nerve block, 3 – group IPACK+femoral nerve); (*p ≤0.05 – compared with group 1)

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6. Fig. 5. Comparison of the motor block in groups according to the Bromage scale (1 – group IPACK+ACB, 2 – group with femoral nerve block, 3 – group IPACK+femoral nerve); (*p ≤0.05 – compared with group 1)

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