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J Knee Surg 2023; 36(12): 1289-1296
DOI: 10.1055/s-0042-1755355
Original Article

Integrating IPACK (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) Block in an Enhanced Recovery after Surgery Pathway for Total Knee Arthroplasty—A Prospective Triple-Blinded Randomized Controlled Trial

Poonam Pai BH
1   Department of Anesthesiology, Mount Sinai Health System, New York, New York
,
Samiat Jinadu
1   Department of Anesthesiology, Mount Sinai Health System, New York, New York
,
Olubunmi Okunlola
1   Department of Anesthesiology, Mount Sinai Health System, New York, New York
,
Haider Darkzali
2   Department of Anesthesiology, University of Iowa, Iowa City, Iowa
,
Hung Mo Lin
1   Department of Anesthesiology, Mount Sinai Health System, New York, New York
,
Yan H. Lai
1   Department of Anesthesiology, Mount Sinai Health System, New York, New York
› Author Affiliations Funding None.
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Abstract

We explored the efficacy of an interspace between the popliteal artery and capsule of the posterior knee (IPACK) block when added to an established enhanced recovery after surgery (ERAS) pathway to assist with posterior knee analgesia and functional mobility after total knee arthroplasty (TKA). We recruited participants undergoing TKA in our prospective, randomized, triple-blinded controlled trial. All study patients participated in our ERAS pathway consisting of a primary spinal anesthetic, adductor canal nerve catheter, and periarticular joint infiltration. Patients were randomized to receive an IPACK block or no block. The primary outcome was total postoperative opioid consumption. Secondary outcomes included pain scores, recovery unit length of stay, time to first opioid use, the incidence of posterior knee pain, ambulation distance and activities of daily living on postoperative day 1, and hospital length of stay. A total of 96 patients were randomized to the control and IPACK groups. There were no statistical differences in primary or majority of secondary outcomes. There was a lower incidence of posterior knee pain (39%) in the IPACK group when compared with controls (8.7%), p < 0.01. In terms of opioid consumption and a majority of functional outcomes, our study demonstrates no overall benefits of adding an IPACK block in this ERAS pathway in TKA. Nevertheless, IPACK may have the potential of mitigating posterior knee pain after TKA. Level of evidence: level 1.

Clinical trial number and registry URL: NCT03653416. www.clinicaltrials.gov.

Keywords

IPACK block - total knee arthroplasty (TKA) - adductor canal block (ACB) - enhanced recovery after surgery (ERAS)

Supplementary Material



Publication History

Received: 01 March 2022

Accepted: 19 June 2022

Article published online:
09 August 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Letter to this article:

Targeting Safe Analgesia of the Posterior Knee CapsuleJ Knee Surg 2024; 37(01): 084-084
DOI: 10.1055/a-1965-4283

 

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