Ultrasound Guided Infiltration of Popliteal Artery and Capsule of Knee [IPACK] versus IPACK with Adductor Canal Block [ACB] for Postoperative Knee Surgery Analgesia: A Comparative Study

Shehata, Mohamed Arafa Mohamed; Sharf, Mohammed Samy; El-komity, Ali Abdullah; Abdelattif, Ahmed Farag

doi:10.21608/ijma.2023.167712.1524

Ultrasound Guided Infiltration of Popliteal Artery and Capsule of Knee [IPACK] versus IPACK with Adductor Canal Block [ACB] for Postoperative Knee Surgery Analgesia: A Comparative Study

Document Type : Original Article

Authors

¹ Department of Anesthesia, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt

² Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

10.21608/ijma.2023.167712.1524

Abstract

Background: Perioperative pain control largely affects postoperative recovery and surgical outcome. Post-operative pain after knee surgery may delay early ambulation and impair quality of recovery. Relieving postoperative pain provides functional recovery which leads to early rehabilitation.
Aim of the work: To evaluate and compare postoperative analgesia and efficiency of IPACK in combination with ACB with IPACK alone using the visual analogue scale [VAS] for postoperative pain assessment after knee arthroscopic surgery as primary outcome. Also, hemodynamic changes, total opioid consumption and patient satisfaction as secondary outcomes.
Patients and Methods: This prospective comparative randomized clinical trial included 60 patients, aged 21-60 years, who underwent elective knee arthroscopic surgery. They were divided into two groups; group I [control group]: a local anesthetic was injected between the popliteal artery and the knee joint capsule. This procedure is known as an IPACK block, and group II [ACB group] received IPACK block plus adductor canal block [ACB].
Results: Our study demonstrated that there was a statistically significant lower pain score assessed by VAS score after 16 hours among IPACK plus ACB group than IPACK alone group with p-value <0.001. Also, there was a statistically significant increased 1st time for request analgesia and increased patient satisfaction in IPACK+ ACB compared to IPACK alone with p-value <0.001. Also, there is a statistically significant higher MAP and HR at 16 hours with IPACK alone group compared to IPACK+ Adductor block group with p-value <0.05.
Conclusion: Combination of IPACK and ACB after knee surgeries better than IPACK alone regarding reducing postoperative pain, 1^st time to rescue analgesia and patient satisfaction, with less effects on hemodynamics.

Keywords