Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty

Madiha Kafeel; Shankaranarayana Paniye; Shilpa Gopala Krishna Bhat

doi:doi:10.11648/j.ijacm.20210902.11

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Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty

Madiha Kafeel, Shankaranarayana Paniye, Shilpa Gopala Krishna Bhat

Published in International Journal of Anesthesia and Clinical Medicine (Volume 9, Issue 2)

Received: 24 May 2021 Accepted: 30 June 2021 Published: 8 July 2021

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Abstract

BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8^th hr, 12^th hr and 24^th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 9, Issue 2)
DOI	10.11648/j.ijacm.20210902.11
Page(s)	23-27
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Total Knee Arthroplasty, Adductor Canal Block, IPACK, Visual Analogue Scale, Postoperative Analgesia

References

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[2]	Rasouli MR, Viscusi ER. Adductor Canal Block for Knee Surgeries: An Emerging Analgesic Technique. Arch bone Jt Surg. 2017; 5 (3): 131-132.
[3]	Sankineani SR, Reddy ARC, Eachempati KK, Jangale A, Gurava Reddy A V. Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in imme. Eur J Orthop Surg Traumatol. 2018; 28 (7): 1391-1395. doi: 10.1007/s00590-018-2218-7.
[4]	Kim DH, Beathe JC, Lin Y, et al. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg. 2019; 129 (2): 526-535. doi: 10.1213/ANE.0000000000003794.
[5]	Eccles CJ, Swiergosz AM, Smith AF, Bhimani SJ, Smith LS, Malkani AL. Decreased Opioid Consumption and Length of Stay Using an IPACK and Adductor CanalNerve Block Following Total Knee Arthroplasty. J Knee Surg. November 2019. doi: 10.1055/s-0039-1700840.
[6]	Thobhani S, Scalercio L, Elliott CE, et al. Novel Regional Techniques for Total Knee Arthroplasty Promote Reduced Hospital Length of Stay: An Analysis of 106 Patients. OchsnerJ. 2017; 17 (3): 233-238.
[7]	Terkawi AS, Mavridis D, Sessler DI, et al. Pain Management Modalities after Total Knee Arthroplasty: A Network Meta-analysis of 170 Randomized Controlled Trials. Anesthesiology. 2017; 126 (5): 923-937. doi: 10.1097/ALN.0000000000001607.
[8]	Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Current pain and headache reports. 2017 May 1; 21 (5): 23.
[9]	Reddy D, Jangale A, Reddy D, Sagi M, Gaikwad D, Reddy D. To compare effect of combined block of adductor canal block (ACB) with IPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee) and adductor canal block (ACB) alone on Total knee replacement in immediate postoperative rehabili. Int J Orthop Sci. 2017; 3: 141-145. doi: 10.22271/ortho.2017.v3.i2c.21.
[10]	Kandarian B, Indelli PF, Sinha S, Hunter OO, Wang RR, Kim TE, Kou A, Mariano ER. Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement. Korean journal of anesthesiology. 2019 Jun; 72 (3): 238.
[11]	Tak R, Reddy AG, Jhakotia K, Karumuri K, Sankineani SR. Continuous adductor canal block is superior to adductor canal block alone or adductor canal block combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) in postoperative analgesia and ambulation following total knee arthroplasty: randomized control trial. Musculoskeletal surgery. 2020 Sep 27: 1-8.
[12]	Singtana K. Comparison of adductor canal block and ipack block with adductor canal block alone for postoperative pain control in patients undergoing total knee arthroplasty. Thai Journal of Anesthesiology. 2021; 47 (1): 1-9.
[13]	D’Souza RS, Langford BJ, Olsen DA, Johnson RL. Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. Local and Regional Anesthesia. 2021; 14.
[14]	Jung DW, Shon WY, Seo SS, Kim OG, Lee IS. Comparison of the postoperative analgesic effect for infiltration between the popliteal artery and the capsule of the posterior knee and that of periarticular multimodal drug injection in total knee arthroplasty: retrospective study in the immediate postoperative period. Knee Surgery & Related Research. 2020 Dec; 32 (1): 1-9.
[15]	Scimia P, Giordano C, Ricci EB, Budassi P, Petrucci E, Fusco P. The ultrasound-guided iPACK block with continuous adductor canal block for total knee arthroplasty. Anaesthesia Cases. 2017 Jan; 5 (1): 74-8.
[16]	Sinha SK, Clement A, Surette AM. Infiltration between the popliteal artery and capsule of the knee (iPACK): essential anatomy, technique, and literature review. Current Anesthesiology Reports. 2019 Dec; 9 (4): 474-8.
[17]	Vichainarong C, Kampitak W, Tanavalee A, Ngarmukos S, Songborassamee N. Analgesic efficacy of infiltration between the popliteal artery and capsule of the knee (iPACK) block added to local infiltration analgesia and continuous adductor canal block after total knee arthroplasty: a randomized clinical trial. Regional Anesthesia & Pain Medicine. 2020 Nov 1; 45 (11): 872-9.

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APA Style

Madiha Kafeel, Shankaranarayana Paniye, Shilpa Gopala Krishna Bhat. (2021). Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. International Journal of Anesthesia and Clinical Medicine, 9(2), 23-27. https://doi.org/10.11648/j.ijacm.20210902.11

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ACS Style

Madiha Kafeel; Shankaranarayana Paniye; Shilpa Gopala Krishna Bhat. Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. Int. J. Anesth. Clin. Med. 2021, 9(2), 23-27. doi: 10.11648/j.ijacm.20210902.11

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AMA Style

Madiha Kafeel, Shankaranarayana Paniye, Shilpa Gopala Krishna Bhat. Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. Int J Anesth Clin Med. 2021;9(2):23-27. doi: 10.11648/j.ijacm.20210902.11

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@article{10.11648/j.ijacm.20210902.11,
  author = {Madiha Kafeel and Shankaranarayana Paniye and Shilpa Gopala Krishna Bhat},
  title = {Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {9},
  number = {2},
  pages = {23-27},
  doi = {10.11648/j.ijacm.20210902.11},
  url = {https://doi.org/10.11648/j.ijacm.20210902.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20210902.11},
  abstract = {BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8th hr, 12th hr and 24th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.},
 year = {2021}
}

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TY  - JOUR
T1  - Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty
AU  - Madiha Kafeel
AU  - Shankaranarayana Paniye
AU  - Shilpa Gopala Krishna Bhat
Y1  - 2021/07/08
PY  - 2021
N1  - https://doi.org/10.11648/j.ijacm.20210902.11
DO  - 10.11648/j.ijacm.20210902.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 23
EP  - 27
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20210902.11
AB  - BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8th hr, 12th hr and 24th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.
VL  - 9
IS  - 2
ER  -

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Author Information

Madiha Kafeel

Department of Anaesthesiology, Yenepoya Medical College, Mangalore, India
Shankaranarayana Paniye

Department of Anaesthesiology, Yenepoya Medical College, Mangalore, India
Shilpa Gopala Krishna Bhat

Department of Anaesthesiology, Yenepoya Medical College, Mangalore, India

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APA Style

Madiha Kafeel, Shankaranarayana Paniye, Shilpa Gopala Krishna Bhat. (2021). Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. International Journal of Anesthesia and Clinical Medicine, 9(2), 23-27. https://doi.org/10.11648/j.ijacm.20210902.11

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ACS Style

Madiha Kafeel; Shankaranarayana Paniye; Shilpa Gopala Krishna Bhat. Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. Int. J. Anesth. Clin. Med. 2021, 9(2), 23-27. doi: 10.11648/j.ijacm.20210902.11

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AMA Style

Madiha Kafeel, Shankaranarayana Paniye, Shilpa Gopala Krishna Bhat. Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty. Int J Anesth Clin Med. 2021;9(2):23-27. doi: 10.11648/j.ijacm.20210902.11

Copy | Download

@article{10.11648/j.ijacm.20210902.11,
  author = {Madiha Kafeel and Shankaranarayana Paniye and Shilpa Gopala Krishna Bhat},
  title = {Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {9},
  number = {2},
  pages = {23-27},
  doi = {10.11648/j.ijacm.20210902.11},
  url = {https://doi.org/10.11648/j.ijacm.20210902.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20210902.11},
  abstract = {BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8th hr, 12th hr and 24th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.},
 year = {2021}
}

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TY  - JOUR
T1  - Comparative Study of Adductor Canal Block with Adductor Canal Block Plus Ipack for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty
AU  - Madiha Kafeel
AU  - Shankaranarayana Paniye
AU  - Shilpa Gopala Krishna Bhat
Y1  - 2021/07/08
PY  - 2021
N1  - https://doi.org/10.11648/j.ijacm.20210902.11
DO  - 10.11648/j.ijacm.20210902.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 23
EP  - 27
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20210902.11
AB  - BACKGROUND: Total Knee Arthroplasty (TKA) is a common surgical procedure for advanced osteoarthritis. Pain management in patients undergoing TKA is the critical component for better recovery and early ambulation. Peripheral nerve blocks is a better alternative to systemic analgesics in relieving pain after TKA. The aim of the study was to compare the VAS score and rescue analgesia requirement in ACB+IPACK group compared to ACB alone in patients undergoing the total knee arthroplasty. METHOD: This observational study is conducted in Yenepoya Medical College Hospital, Mangalore who are in the age group from 40 to 80 years admitted for elective total knee replacement surgery during the period of October 2020 to December 2020 after approval from the ethical committee and written informed consent from participants. The patients were selected by closed envelope method into two groups; as group 1 patients received ACB+IPACK and group 2 received ACB only. Pain assessment was done by a 10 cm visual analogue scale (VAS); 0: no pain; 10: worst imaginable pain. Patient were reassessed for pain and any side effects like nausea, vomiting, gastric irritation and respiratory depression at 8 hours, 12 hours and 24 hours or till the need of rescue analgesia. RESULT: The mean age of the patients in the study group was 58.7 years. The VAS score atrest after 8th hr, 12th hr and 24th hr showed a significantly lower score in ACB+IPACK group compared to the ACB group. However, there was no significant pain noted in two groups to provide the rescueanalgesics. CONCLUSION: ACB+IPACK is safer and efficient than ACB alone for postoperative pain management in patients undergoing total knee arthroplasty.
VL  - 9
IS  - 2
ER  -

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