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

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, 1st time to rescue analgesia and patient satisfaction, with less effects on hemodynamics.

Keywords

• knee joint
• visual analog scale
• popliteal artery
• hemodynamics
• postoperative pain