Comparison of Analgesic Efficacies of the iPACK (Interspace Between the Popliteal Artery and Capsule of the Posterior Knee) and Genicular Nerve Blocks Used in Combination With the Continuous Adductor Canal Block After Total Knee Arthroplasty: A Randomized Clinical Trial |
| |
| Affiliation: | 1. Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;2. Department of Orthopedics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;5. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts;6. Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia;7. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;8. Department of Orthopaedic Surgery, University of Washington, Seattle, Washington;9. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York;10. Department of Orthopaedic Surgery, Stanford University, Redwood City, California;11. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia;12. Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, California;13. Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, Texas;1. Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;2. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas;3. Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee;4. Novant Health Orthopaedics and Sports Medicine, Winston-Salem, North Carolina;1. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh;2. Department of Orthopaedics, University of Edinburgh, Edinburgh;3. Golden Jubilee National Hospital, Glasgow;4. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow;1. Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania;2. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland;1. Mayo Clinic, Rochester, Minnesota;2. University of Florida, Gainesville, Florida |
| |
| Abstract: | BackgroundThe interspace between the popliteal artery and capsule of the posterior knee (iPACK) block and the genicular nerve block (GNB) are motor-sparing nerve blocks used for knee pain relief. We compared the analgesic efficacies of ultrasound-guided iPACK block and GNB when combined with continuous adductor canal block after total knee arthroplasty.MethodsIn this randomized control study, 132 total knee arthroplasty patients were assigned to the iPACK, GNB, and iPACK + GNB groups. All patients received combined spinal anesthesia and continuous adductor canal block. The primary outcome was the 8-hour postoperative pain score during movement. Secondary outcomes were pain scores, posterior knee pain, intravenous morphine consumption, and tibial and common peroneal nerve sensorimotor function. All included patients completed the study.ResultsThe 4-hour and 8-hour postoperative pain scores during movement were significantly lower in the iPACK + GNB group than that in the iPACK group (−2.5 [3.6, 1.3]; P < .001 and −2 [-3, −1]; P < .001, respectively). The differences in rating pain scores and posterior knee pain were not clinically relevant. The iPACK group demonstrated a significantly higher intravenous morphine consumption than did the GNB and iPACK + GNB groups during the first 48 hours postoperatively (P < .001) but were not clinically relevant. There was no incidence of complete sensorimotor blockade in any of the groups.ConclusionThe iPACK–GNB combination relieved pain during movement better than the iPACK block alone during the 8 hours postoperatively after total knee arthroplasty in setting of multimodal analgesia such as adductor canal block. |
| |
| Keywords: | pain postoperative arthroplasty knee nerve block ultrasound |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
