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

Anesthesia and Analgesia
David H KimStavros G Memtsoudis

Abstract

Periarticular injections (PAIs) are becoming a staple component of multimodal joint pathways. Motor-sparing peripheral nerve blocks, such as the infiltration between the popliteal artery and capsule of the posterior knee (IPACK) and the adductor canal block (ACB), may augment PAI in multimodal analgesic pathways for knee arthroplasty, but supporting literature remains rare. We hypothesized that the addition of ACB and IPACK to PAI would lower pain on ambulation on postoperative day (POD) 1 compared to PAI alone. This triple-blinded randomized controlled trial included 86 patients undergoing unilateral total knee arthroplasty. Patients either received (1) a PAI (control group, n = 43) or (2) an IPACK with an ACB and modified PAI (intervention group, n = 43). The primary outcome was pain on ambulation on POD 1. Secondary outcomes included numeric rating scale (NRS) pain scores, patient satisfaction, and opioid consumption. The intervention group reported significantly lower NRS pain scores on ambulation than the control group on POD 1 (difference in means [95% confidence interval], -3.3 [-4.0 to -2.7]; P < .001). In addition, NRS pain scores on ambulation on POD 0 (-3.5 [-4.3 to -2.7]; P < .001) and POD 2 (-1.0 [-1.9 to -0.1]; P ...Continue Reading

References

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Citations

May 8, 2019·Regional Anesthesia and Pain Medicine·John TranVincent Chan
Jun 13, 2020·Current Opinion in Anaesthesiology·Pamela A ChiaChristine C Myo Bui
Sep 2, 2020·Regional Anesthesia and Pain Medicine·Jason OchrochNabil M Elkassabany
Oct 31, 2019·Orthopaedic Surgery·Jing-Wen LiLiang-Kun Xiao
Jun 21, 2020·Regional Anesthesia and Pain Medicine·Eric S Schwenk, Rebecca L Johnson
Sep 23, 2020·Minerva anestesiologica·Ece Yamak Altinpulluk, Alparslan Turan
May 9, 2021·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Neil A HansonRobert H Thiele
Jun 20, 2021·Regional Anesthesia and Pain Medicine·David H KimStavros G Memtsoudis
Jul 8, 2021·The Journal of Bone and Joint Surgery. American Volume·Joseph A KaramJavad Parvizi
Aug 8, 2021·Journal of Clinical Anesthesia·Jiyoung KimHue Jung Park
Sep 1, 2021·Expert Review of Neurotherapeutics·Abhishek K GuptaSergio Bergese
Jan 19, 2021·BJA Education·S ShevlinL Turbitt

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