Comparative study between the analgesic efficacy of adductor canal block alone and adductor canal with IPACK (interspace between popliteal artery and capsule of the knee) block for knee surgeries

Abstract

ABSTRACT Background Knee surgeries are needed in a wide range of patients, from young athletes with anterior cruciate ligament injuries up to old patients with comorbidities presenting for arthroscopy up to total knee replacement procedures. The trend is fast track knee surgery with early ambulation and hospital discharge, so analgesic options of neuraxial blocks and main nerve blocks are less attractive due to the unavoidable muscle weakness. In this study, the benefit of pure sensory nerve block could be reached. Aim of the study To compare the postoperative range of motion and the analgesic efficacy of adductor canal block (ACB) alone against adductor canal with IPACK (interspace between popliteal artery and capsule of the knee) block in knee surgeries. Patients and methods The study is a randomized, prospective, comparative study where 50 patients subjected to knee surgeries were randomized into two groups: Group (A): patients in this group received ultrasound-guided ACB only; Group (AB): under ultrasound guide, patients in this group received a combined ACB and IPACK block at the start of surgery. Results Regarding pain control over the first 24hours following surgery, range of motion and walking distance; there were statistical differences between both groups. When demographic information such age, sex, BMI, and ASA scores were examined between the two groups, there was no statistically significant difference between them (p-value > 0.05). Additionally, there was no statistically significant difference between groups in terms of opioid needs or consumption. Conclusion Regardless of the good analgesic effect of ACB, patients who received a combination of ACB and IPACK blocks have experienced a better pain control, a wider range of motion and a longer walking distance following surgery when compared to patients who received ACB alone.