![]() ![]() Methods:Ī sample of 60 cases who were scheduled for elective unilateral TKA were divided into two groups using random number table method: a group with IPACK combined with an adductor canal block (I group, n = 30), and a group with femoral nerve block combined with superior popliteal sciatic nerve block (FS group, n = 30). Since both blocks offered similar postoperative analgesic effects, IPACK block would be a better choice for controlling posterior knee pain after TKA with more preserved motor function of the sciatic nerve compared with SNB when combined with continuous femoral nerve block.This study aimed to evaluate the impact of Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) combined with an adductor canal block under the guidance of ultrasound on early motor function after Total Knee Arthroplasty (TKA). ![]() Motor blockade of the sciatic nerve was also observed after IPACK block on the day of surgery, but the incidence rate was lower compared with SNB. No apparent complications related to blocks was observed. VAS pain scores and analgesic requirements were similar between the two groups. No difference was observed in motor function on postoperative days 1 and 2. Severe or moderate motor blockade of the sciatic nerve was observed in 4 patients (15.4%) in group I after surgery, whereas the same incident was observed in 32 patients (40.5%) in group S (p=0.020). One hundred and fourteen patients were identified for analysis (83 and 31 patients for groups S and I, respectively). Motor function and pain scores were compared between the two groups. Those data were taken by assessors who were blind to the blocks conducted in each patient. The data analyzed included muscle strength of the tibialis anterior, extensor hallucis longus and gastrocnemius muscles assessed using manual muscle testing (MMT), postoperative visual analogue scale (VAS) pain scores, postoperative analgesic requirements within 48 h and complications. Continuous infusion of 0.125% levobupivacaine at a rate of 4 ml/h for femoral nerve block was started immediately after surgery and continued for 48 h. Patients in group I received IPACK block using 0.375% ropivacaine 20 ml. Twenty ml of 1.5% mepivacaine was injected for the subgluteal approach to SNB for patients in group S. A 25G catheter-over-needle was inserted for continuous FNB and 15 ml of 0.375% ropivacaine was injected. All the blocks were conducted under ultrasound guidance preoperatively. Group S included patients receiving SNB and group I included those receiving IPACK block. ![]() We extracted data of two groups of patients. Patients who received continuous SNB or spinal anesthesia were excluded from analysis. All patients received general anesthesia, continuous femoral nerve block and intra-articular local anesthetic injection. ![]() Patients who underwent unilateral TKA between May 2017 and December 2020 were identified. With IRB approval, we analyzed data saved in our regional anesthesia database and medical records. The present study retrospectively analyzed data saved in our institutional registry and medical records to evaluate the incidence rate of motor blockade after IPACK block and compared the motor blockade and analgesic effects between IPACK block and SNB in patients undergoing TKA. There is still limited information available on the incidence rate and severity of motor blockade after IPACK block and few studies have compared motor blockade after IPACK and sciatic nerve blocks. IPACK block has been described to have superiority over sciatic nerve block with motor-sparing effect, however recent studies and case reports have suggested that motor blockade of the sciatic nerve also occurs after IPACK block. Sciatic nerve block (SNB) and newly developed local anesthetic infiltration between the popliteal artery and capsule of the knee (IPACK) block can reduce pain on the posterior part. Femoral nerve block or adductor canal block have been used to control anterior knee pain. Total knee arthroplasty (TKA) causes severe postoperative pain, which requires a combination of peripheral nerve blocks for effective analgesia. Shimane University Hospital, Izumo, Japanĭisclosures: K. Kotaro Gunji, M.D., Shinichi Sakura, M.D., Yuki Aoyana, M.D., Yoshimi Nakaji, M.D., Yoji Saito, M.D. Ipack Versus Sciatic Nerve Block: Effects On Motor Block And Analgesia After Total Knee Arthroplasty ![]()
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