Comparison of genicular nerve block and its combination with IPACK block for analgesia and recovery after total knee arthroplasty: a randomized trial.

研究概要

63 patients undergoing elective total knee arthroplasty (TKA) were randomized and analyzed into three groups: control (standard analgesia), genicular nerve block (GNB), and GNB combined with Infiltration between Popliteal Artery and PosterIor Capsule of Knee (iPACK) block. The primary outcome was VAS pain score at 8 hours with mobility. Secondary outcomes included VAS scores at 2, 4, 6, 12, 18, and 24 hours at rest and with motion, time to first rescue analgesia, total 24-hour morphine consumption, quadriceps strength, knee range of motion (ROM), 2-minute walk test, Timed Up and Go (TUG) test, and patient satisfaction. Overall, the results of the study revealed that the combination group demonstrated significantly lower VAS scores at nearly all measured time points except at 12 hours compared with the GNB group, and consistently lower scores compared with control. Time to first rescue analgesia was longest in the combination group, and 24-hour morphine consumption was lowest in the combination group. The combination group also showed superior functional recovery and satisfaction. These findings suggest that adding iPACK to GNB provides optimal early analgesia and enhances immediate postoperative recovery.