Korean J Anesthesiol.
2019 Jun;72(3):238-244. 10.4097/kja.d.18.00346.
Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement
- Affiliations
-
- 1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. emariano@stanford.edu
- 2Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
- 3Orthopedic Surgery Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- 4Department of Anesthesiology, St. Francis Hospital and Medical Center, Hartford, CT, USA.
- 5Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- KMID: 2454882
- DOI: http://doi.org/10.4097/kja.d.18.00346
Abstract
- BACKGROUND
The Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block is a new anesthesiologist- administered analgesic technique for controlling posterior knee pain that has not yet been well studied in total knee arthroplasty (TKA) patients. We compared pain outcomes in TKA patients before and after implementation of the IPACK with the hypothesis that patients receiving IPACK blocks will report lower pain scores on postoperative day (POD) 0 than non-IPACK patients.
METHODS
With Institutional Review Board approval, we retrospectively reviewed data for consecutive TKA patients by a single surgeon 4 months before (PRE) and after (POST) IPACK implementation. All TKA patients received adductor canal catheters and peri-operative multimodal analgesia. The primary outcome was pain on POD 0. Other outcomes were daily pain scores, opioid consumption, ambulation distance, length of stay, and adverse events within 30 days.
RESULTS
Post-implementation, 48/50 (96%) of TKA patients received an IPACK block, and they were compared with 32 patients in the PRE group. On POD 0, the lowest pain score (median [10th-90th percentiles]) was significantly lower for the POST group compared to the PRE group (0 [0-4.3] vs. 2.5 [0-7]; P = 0.003). The highest patient-reported pain scores on any POD were similar between groups with no differences in other outcomes.
CONCLUSIONS
Within a multimodal analgesic protocol, addition of IPACK blocks decreased the lowest pain scores on POD 0. Although other outcomes were unchanged, there may be a role for new opioid-sparing analgesic techniques, and changing clinical practice change can occur rapidly.
Keyword
MeSH Terms
Cited by 2 articles
-
Point-of-care ultrasonography as rescue for popliteal artery cannulation in prone position
Chitta Ranjan Mohanty, Snigdha Bellapukonda, Nitish Topono, Satyaki Sarkar, Priyank Tapuria
Korean J Anesthesiol. 2021;74(3):276-277. doi: 10.4097/kja.20513.The analgesic efficacy of anterior femoral cutaneous nerve block in combination with femoral triangle block in total knee arthroplasty: a randomized controlled trial
Wirinaree Kampitak, Aree Tanavalee, Tanvaa Tansatit, Srihatach Ngarmukos, Nattaporn Songborassamee, Chutikant Vichainarong
Korean J Anesthesiol. 2021;74(6):496-505. doi: 10.4097/kja.21120.
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- 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
- A cadaveric study investigating the spread of injectate following an interspace between the popliteal artery and the capsule of the posterior knee block in a neonatal sample: a pilot study
- Adductor Canal Block Combined with Interspace between the Popliteal Artery and Capsule of the Knee (iPACK) versus Periarticular Injection for Total Knee Arthroplasty
- 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
- Popliteal Artery Occlusion after Total Knee Replacement Arthroplasty: A Case Report
