scholarly journals Optimal location of local anesthetic injection in the interspace between the popliteal artery and posterior capsule of the knee (iPACK) for posterior knee pain after total knee arthroplasty: an anatomical and clinical study

2019 ◽  
Vol 72 (5) ◽  
pp. 486-494 ◽  
Author(s):  
Wirinaree Kampitak ◽  
Tanvaa Tansatit ◽  
Aree Tanavalee ◽  
Srihatach Ngarmukos
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Study ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Popliteal Artery ◽  
Optimal Location ◽  
Total Knee ◽  
Local Anesthetic Injection ◽  
Posterior Knee

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

2020 ◽  
Vol 45 (4) ◽  
pp. 267-276 ◽  
Author(s):  
Wirinaree Kampitak ◽  
Aree Tanavalee ◽  
Srihatach Ngarmukos ◽  
Saran Tantavisut
Keyword(s):  
Total Knee Arthroplasty ◽  
Motor Function ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Popliteal Artery ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Motor Blockade ◽  
Total Knee ◽  
Posterior Knee

Background and objectiveAn ultrasound-guided anesthetic technique targeting the interspace between the popliteal artery and capsule of the posterior knee (iPACK) can provide posterior knee analgesia with preserved motor function after total knee arthroplasty (TKA). This study compared the peroneal nerve motor-sparing effects of iPACK block and tibial nerve block (TNB) when combined with local infiltration analgesia (LIA) and continuous adductor canal block (CACB).MethodsIn this study, 105 patients scheduled for elective TKA were randomized to receive proximal iPACK block (iPACK1), distal iPACK block (iPACK2), or TNB, along with spinal anesthesia, modified LIA, and CACB. The primary outcome was the incidence of common peroneal nerve (CPN) motor blockade. Secondary outcomes included CPN sensory function, tibial sensorimotor function, posterior knee pain, pain score, intravenous morphine requirement, timed up-and-go test, quadriceps muscle strength, range of motion, length of hospital stay, patient satisfaction, and adverse events.ResultsThe incidence of CPN motor blockade was significantly higher in the TNB group than in the iPACK1 (p=0.001) and iPACK2 (p=0.001) groups, but was not significant between the iPACK1 and iPACK2 groups (p=0.76). Tibial nerve motor function was more preserved in the iPACK1 and iPACK2 groups than in the TNB group (p<0.001 and p<0.001, respectively). Complete CPN and tibial sensorimotor blockade were not observed in the iPACK2 group. Posterior knee pain score was significantly higher in the iPACK1 group than in other groups during the 24-hour postoperative period (p=0.001).ConclusionsCompared with TNB, iPACK1 and iPACK2 preserved CPN and tibial nerve motor function to a greater extent. However, iPACK2 did not demonstrate complete CPN and tibial nerve motor blockade while maintaining effective posterior knee pain relief.Trial registration numberTCTR20180206002.

scholarly journals The Analgesic Effects of Proximal, Distal, or No Sciatic Nerve Block on Posterior Knee Pain after Total Knee Arthroplasty

2014 ◽  
Vol 121 (6) ◽  
pp. 1302-1310 ◽  
Author(s):  
Faraj W. Abdallah ◽  
Vincent W. S. Chan ◽  
Rajiv Gandhi ◽  
Arkadiy Koshkin ◽  
Sherif Abbas ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Sciatic Nerve ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Severe Pain ◽  
Procedural Time ◽  
Total Knee ◽  
Posterior Knee ◽  
Anterior Knee

Abstract Background: The analgesic efficacy of sciatic nerve block (SNB) after total knee arthroplasty (TKA) is unclear. Proximal and distal SNB are each reported to provide posterior knee analgesia, whereas others suggest that posterior knee pain is not important after TKA. This prospective, randomized, double-blind, parallel-arm, placebo-controlled trial examined whether proximal or distal SNB provides superior analgesia in the posterior knee compared with no SNB after TKA. Methods: Sixty patients undergoing TKA were randomized to single-shot SNB using either the infragluteal (Proximal group) or popliteal (Distal group) technique, or no SNB (Placebo group). All patients received spinal anesthesia and continuous-femoral nerve blockade. A blinded observer assessed posterior and anterior knee pain at 2, 4, 6, 8, 12, and 24 h postoperatively. The primary outcome was moderate-to-severe posterior knee pain at 4 h postoperatively; secondary outcomes included SNB procedural time, needle passes, and discomfort. Results: Fifty-three patients were analyzed. The proportion of patients (Proximal:Distal:Placebo) who experienced moderate-to-severe posterior knee pain was 18%:22%:89% (P &lt; 0.00001) at 2 h, 24%:28%:72% (P &lt; 0.01) at 4 h, and 12%:17%:78% (P = 0.00003) at 6 h postoperatively. For the anterior knee, the proportion of patients reporting moderate-to-severe pain was 6%:11%:44% (P = 0.02) at 2 h, 6%:6%:39% (P = 0.012) at 4 h, and 12%:6%:44% (P = 0.017) at 6 h postoperatively. Moderate-to-severe pain did not differ between groups beyond 6 h. Both proximal and distal SNB reduced rest pain in the posterior and anterior knee up to 8 h postoperatively compared with no SNB. The popliteal technique required shorter procedural time, fewer needle passes, and produced less discomfort. Conclusion: Proximal and distal SNB each reduce posterior and anterior knee pain after TKA compared with no SNB.

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