![]() © American Society of Regional Anesthesia & Pain Medicine 2019. Nerve blockade of branches of sciatic nerve innervating posterior aspect of popliteal fossa iPACK block targets articular branches of tibial, common peroneal. Alternate Title: Bloqueo IPACK: Complemento analgsico emergente en. Further clinical study is required to confirm our cadaveric findings.Īnatomy iPACK joint innervation knee joint nerve blocks. IPACK block: emerging complementary analgesic technique for total knee arthroplasty. The proximal injection technique promoted greater anteromedial dye spread, while the distal injection had more anterolateral spread. Other articular branches were stained with variable frequency.īoth proximal and distal iPACK injection techniques provided a similar area of dye spread in the popliteal region and extensive staining of the articular branches supplying the posterior capsule. ![]() ![]() The proximal injection resulted in staining of superior medial genicular nerve, due to dye spread through the adductor hiatus, whereas superior lateral genicular nerve and anterior branch of common fibular nerve were consistently stained following distal injection. Of the four articular branches supplying the posterior knee joint capsule, the genicular branch of posterior division of obturator nerve was stained in all specimens. Following injection, dissection, digitization, and 3D modeling were performed to map the area of dye spread and determine the frequency of nerve staining.īoth injection techniques achieved a similar mean area of injectate spread. This cadaveric study aimed to compare the area of dye spread and frequency of articular branches staining following a proximal versus distal injection technique.Īn ultrasound-guided iPACK injection (10 mL of methylene blue dye solution) was performed in 14 lightly embalmed specimens: 7 injected using a proximal injection technique (1 fingerbreadth above base of patella) and 7 using a distal injection technique (at the superior border of the femoral condyles). The extent of injectate spread and the number of articular branches affected is currently unknown. The mean ROM of knee and ambulation distance also showed significantly better values in ACB + IPACK group compared to the ACB group.ĪCB + IPACK is a promising technique that offers improved pain management in the immediate postoperative period without affecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.Īdductor canal block IPACK Knee arthroplasty Postoperative analgesia.Ultrasound-guided infiltration of the interspace between the popliteal artery and capsule of the knee (iPACK) block, a new regional analgesic technique, is believed to relieve posterior knee pain, after total knee arthroplasty, by targeting the articular branches innervating posterior aspect of the joint. VAS score showed significantly (p < 0.005) better values in ACB + IPACK group compared to the ACB group. The secondary outcome measures assessed were the range of movement (ROM) and ambulation distance. All patients were evaluated with VAS score for pain recorded at 8 h, postoperative day (POD) 1 and POD 2 after the surgery. ![]() The initial 60 consecutive patients received ACB + IPACK (Group 1, n = 60), and the subsequent 60 patients received ACB alone (Group 2, n = 60). A long thin needle will be inserted on the side of your thigh to inject behind your knee. They will inject this area with a long-acting local anesthetic like novocaine used by your dentist. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves.Ī prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty. The IPACK block is performed using the latest ultrasound equipment to pinpoint the exact location to infiltrate nerves going to your knee joint. Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. ![]()
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