Journal Article

IPACK (Interspace between the Popliteal Artery and the Capsule of the Posterior Knee) Block Combined with SACB (Single Adductor Canal Block) Versus SACB for Analgesia after Total Knee Arthroplasty

Jiang, Xile, Zhu, Weitao, Tang, Xiumei, Wang, Duan, Zhou, Zongke, Lei, Lei, Fu, Zhongmin, Chen, Jiali, Ning, Ning

2022

Overview

Objectives To evaluate the combination of the infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block and single adductor canal block (SACB) versus SACB for motor‐sparing knee analgesia effects after total knee arthroplasty (TKA). Methods PubMed, Ovid, Cochrane Library, and other databases were searched from the inception to January 2021. Randomized controlled trials (RCTs) comparing patients receiving iPACK plus SACB with patients receiving SACB after TKA were included. The included studies were assessed by two reviewers according to the Cochrane risk of bias criteria. Meta‐analysis was performed with STATA 13.0 software, the risk ratios (RR) and mean differences (MD) were used to compare dichotomous and continuous variables. The primary outcome was ambulation pain and secondary outcomes were rest pain, opioid consumption, function ability, clinical outcomes, and complications. Results Seven RCTs (304 knees in iPACK + SACB group; 305 knees in SACB group) were included. The follow‐up periods ranged from 2 days to 3 months. Pooled data indicated lower pain scores at ambulation (p < 0.0001) for iPACK + SACB. When comparing the pain scores of subgroups analyzed at specific periods, lower scores in subgroups within 12 h (at rest and ambulation) and after 48 h (at ambulation) were observed in the iPACK + SACB group. Analysis demonstrated greater reduction in morphine consumption (p = 0.007) in the iPACK + SACB group. The iPACK + SACB group is also superior to the SACB group regarding function ability, which included range of motion (ROM) (p = 0.001), time up to go (TUG) test (p = 0.030), and ambulation distance (p < 0.0001). No difference was found in clinical outcomes or complications. Conclusions With the iPACK added to SACB, pain scores, morphine consumption, functional ability were improved. Additional high‐quality studies are required to further address this topic. Our study confirmed that with the addition of IPACK, SACB could significantly reduce the pain scores, morphine consumption, as well as to improve functional ability.

• Publisher: John Wiley & Sons Australia, Ltd,John Wiley & Sons, Inc,Wiley
• Subject: Bias / Clinical outcomes / Confidence intervals / Handbooks / Intervention / IPACK (interspace between the popliteal artery and posterior capsule of the knee) block / Joint replacement surgery / Knee / Medical personnel / Meta-analysis / Morphine / Muscle strength / Osteoarthritis / Pain / Randomized controlled trials / Range of motion / Regional anesthesia / Review / Rheumatoid arthritis / SACB (single adductor canal block) / Sensitivity analysis / Surgeons / Systematic review and meta‐analysis / Total knee arthroplasty / Ultrasonic imaging