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Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty

Received: 24 May 2021     Accepted: 30 June 2021     Published: 8 July 2021
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Abstract

BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8th hr, 12th hr and 24th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 9, Issue 2)
DOI 10.11648/j.ijacm.20210902.11
Page(s) 23-27
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Total Knee Arthroplasty, Adductor Canal Block, IPACK, Visual Analogue Scale, Postoperative Analgesia

References
[1] Amer N. Combined adductor canal and IPACK blocks is better than combined adductor canal and periarticular injection blocks for painless ACL reconstruction surgery. J Anesth Crit Care Open Access. 2018; 10 (4): 154-157. doi: 10.15406/jaccoa.2018.10.00381.
[2] Rasouli MR, Viscusi ER. Adductor Canal Block for Knee Surgeries: An Emerging Analgesic Technique. Arch bone Jt Surg. 2017; 5 (3): 131-132.
[3] Sankineani SR, Reddy ARC, Eachempati KK, Jangale A, Gurava Reddy A V. 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 imme. Eur J Orthop Surg Traumatol. 2018; 28 (7): 1391-1395. doi: 10.1007/s00590-018-2218-7.
[4] Kim DH, Beathe JC, Lin Y, et al. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg. 2019; 129 (2): 526-535. doi: 10.1213/ANE.0000000000003794.
[5] Eccles CJ, Swiergosz AM, Smith AF, Bhimani SJ, Smith LS, Malkani AL. Decreased Opioid Consumption and Length of Stay Using an IPACK and Adductor CanalNerve Block Following Total Knee Arthroplasty. J Knee Surg. November 2019. doi: 10.1055/s-0039-1700840.
[6] 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. OchsnerJ. 2017; 17 (3): 233-238.
[7] 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. 2017; 126 (5): 923-937. doi: 10.1097/ALN.0000000000001607.
[8] Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Current pain and headache reports. 2017 May 1; 21 (5): 23.
[9] Reddy D, Jangale A, Reddy D, Sagi M, Gaikwad D, Reddy D. To compare effect of combined block of adductor canal block (ACB) with IPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee) and adductor canal block (ACB) alone on Total knee replacement in immediate postoperative rehabili. Int J Orthop Sci. 2017; 3: 141-145. doi: 10.22271/ortho.2017.v3.i2c.21.
[10] Kandarian B, Indelli PF, Sinha S, Hunter OO, Wang RR, Kim TE, Kou A, Mariano ER. 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 journal of anesthesiology. 2019 Jun; 72 (3): 238.
[11] Tak R, Reddy AG, Jhakotia K, Karumuri K, Sankineani SR. Continuous adductor canal block is superior to adductor canal block alone or adductor canal block combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) in postoperative analgesia and ambulation following total knee arthroplasty: randomized control trial. Musculoskeletal surgery. 2020 Sep 27: 1-8.
[12] Singtana K. Comparison of adductor canal block and ipack block with adductor canal block alone for postoperative pain control in patients undergoing total knee arthroplasty. Thai Journal of Anesthesiology. 2021; 47 (1): 1-9.
[13] D’Souza RS, Langford BJ, Olsen DA, Johnson RL. Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. Local and Regional Anesthesia. 2021; 14.
[14] Jung DW, Shon WY, Seo SS, Kim OG, Lee IS. Comparison of the postoperative analgesic effect for infiltration between the popliteal artery and the capsule of the posterior knee and that of periarticular multimodal drug injection in total knee arthroplasty: retrospective study in the immediate postoperative period. Knee Surgery & Related Research. 2020 Dec; 32 (1): 1-9.
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  • APA Style

    Madiha Kafeel, Shankaranarayana Paniye, Shilpa Gopala Krishna Bhat. (2021). Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. International Journal of Anesthesia and Clinical Medicine, 9(2), 23-27. https://doi.org/10.11648/j.ijacm.20210902.11

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    ACS Style

    Madiha Kafeel; Shankaranarayana Paniye; Shilpa Gopala Krishna Bhat. Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. Int. J. Anesth. Clin. Med. 2021, 9(2), 23-27. doi: 10.11648/j.ijacm.20210902.11

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    AMA Style

    Madiha Kafeel, Shankaranarayana Paniye, Shilpa Gopala Krishna Bhat. Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. Int J Anesth Clin Med. 2021;9(2):23-27. doi: 10.11648/j.ijacm.20210902.11

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  • @article{10.11648/j.ijacm.20210902.11,
      author = {Madiha Kafeel and Shankaranarayana Paniye and Shilpa Gopala Krishna Bhat},
      title = {Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {9},
      number = {2},
      pages = {23-27},
      doi = {10.11648/j.ijacm.20210902.11},
      url = {https://doi.org/10.11648/j.ijacm.20210902.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20210902.11},
      abstract = {BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8th hr, 12th hr and 24th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty
    AU  - Madiha Kafeel
    AU  - Shankaranarayana Paniye
    AU  - Shilpa Gopala Krishna Bhat
    Y1  - 2021/07/08
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijacm.20210902.11
    DO  - 10.11648/j.ijacm.20210902.11
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 23
    EP  - 27
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ijacm.20210902.11
    AB  - BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8th hr, 12th hr and 24th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.
    VL  - 9
    IS  - 2
    ER  - 

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Author Information
  • Department of Anaesthesiology, Yenepoya Medical College, Mangalore, India

  • Department of Anaesthesiology, Yenepoya Medical College, Mangalore, India

  • Department of Anaesthesiology, Yenepoya Medical College, Mangalore, India

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