![]() He received oral paracetamol 1 g one hour prior to surgery for preemptive analgesia. We present a 29 year old ASA physical status 1 male (186 cm, 110 Kg, BMI 32), with allergy to non-steroidal anti-inflammatory drugs, who underwent a left knee ACLR with hamstring autograft, medial meniscus repair and extra-articular tenodesis. Written informed consent was provided by all patients for inclusion in this report. The IPACK block was offered to reduce pain, opioid consumption and facilitate early rehabilitation and discharge. These 2 patients were selected as they were under the care of the same surgeon and anesthetist. We describe our experience with the proximal approach of the IPACK block for ACLR. We aim to block the popliteal plexus, saphenous nerve and nerve to vastus medialis with a single injection by redirecting the needle after a single puncture. The transducer is then slid caudally to trace the artery as it dives into the popliteal fossa through the adductor hiatus to become the popliteal artery. In the supine position, the transducer is placed in the medial lower third aspect of the thigh to observe the femoral artery under the sartorius muscle. The IPACK block has evolved from being performed in a prone position where the injection occurs at the popliteal crease at the level of the femoral condyles, to being done with the patient supine. This leads to earlier ambulation, rehabilitation and recovery in various knee surgeries. The technique involves a very selective block of the terminal sensory branches of the posterior aspect of the knee without the involvement of motor branches of the tibial and peroneal nerves leading to reduced pain without motor weakness. The recent technique of ultrasound guided local anesthetic infiltration of the interspace between the popliteal artery and the capsule of posterior knee (IPACK) has shown promising results. Given the multiple innervations of the knee, complete pain relief would not be expected from either the femoral nerve block (FNB) or the saphenous nerve block alone. There are various choices of PNBs available either as a single injection or in combination. A multimodal analgesia regime with peripheral nerve blocks (PNB) is therefore recommended for this procedure. Published by BMJ.Anterior cruciate ligament reconstruction (ACLR) surgery is associated with moderate to severe postoperative pain which can be attributed to both arthroscopic surgery and the graft donor site. © American Society of Regional Anesthesia & Pain Medicine 2020. The IPACK block reduced the incidence of posterior knee pain 6 hours postoperatively.Īnalgesia analgesics anesthesia health care local nerve block opioid outcome assessment. ![]() However, opioid requirements, quality of recovery and functional measures were similar between the two groups. There was marginal improvement in other pain measures in the first 24 hours after surgery. Patients who received the IPACK block had less pain in the back of the knee 6 hours after surgery when compared with the sham block: 21.7% vs 45.8%, p<0.01. Other end points included quality of recovery after surgery, pain scores, opioid requirements, and functional measures. We were set to assess pain in the back of the knee 6 hours after surgery. This prospective randomized controlled trial aimed to assess the analgesic efficacy of adding the IPACK block to our current multimodal analgesic regimen, including the ACB, in patients undergoing primary TKA.ġ19 patients were randomized to receive either an IPACK or a sham block in addition to multimodal analgesia and an ACB. Similarly, local anesthetic injection between the popliteal artery and the posterior capsule of the knee, IPACK block, has been described to provide analgesia to the posterior capsule of the knee with motor-sparing qualities. The adductor canal block (ACB) has gained popularity because of its quadriceps muscle sparing. Peripheral nerve blocks have been integrated into most multimodal analgesia protocols for total knee arthroplasty (TKA).
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