Comparison of Analgesic Efficacies of the iPACK (Interspace Between the Popliteal Artery and Capsule of the Posterior Knee) and Genicular Nerve Blocks Used in Combination With the Continuous Adductor Canal Block After Total Knee Arthroplasty: A Randomized

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研究概要

132 patients between the ages of 50 and 80 years undergoing primary, unilateral total knee arthroplasty (TKA) were included in this single-center, 3-arm, triple blinded trial. Patients were randomized to receive either an interspace between the popliteal artery and capsule of the posterior knee block (iPACK; n=44), genicular nerve block (GNB; n=44) or a combination of the two (iPACK+GNB; n=44) alongside combined spinal anesthesia and continuous adductor canal block. The primary outcome of interest was 8-hour postoperative knee pain during movement, measured using a visual analog scale (VAS). The secondary outcomes of interest included VAS knee pain and posterior knee pain during rest and movement in the post anesthesia care unit (PACU) and at 4, 8, 12, 24, 36, and 48 hours, morphine consumption at 12, 24 and 48 hours, sensorimotor function of the tibial and common peroneal nerve (CPN), timed up and go (TUG) scores, range of motion (ROM), and quadriceps strength (QMS). Additional outcomes included the length of hospital stay, quality of sleep, and patient satisfaction. According to study findings, a significant difference for VAS knee pain during movement, VAS knee pain at rest, and VAS posterior knee pain at rest and during movement was found for all groups at 4, 8, and 12 hours, as well as for VAS knee pain during movement at 24 hours, and VAS knee pain at rest and on movement and VAS posterior knee pain on movement at 48 hours. However, this difference was only clinically significant for the iPACK+GNB group VAS knee pain during movement scores at 4- and 8-hours when compared with the iPACK group. No clinically significant between-group difference was found for any other outcome.