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J Knee Surg 2023; 36(04): 345-353
DOI: 10.1055/s-0041-1733882
Original Article

Does the Addition of iPACK Block to Adductor Canal Block Provide Improved Analgesic Effect in Total Knee Arthroplasty? A Systematic Review and Meta-Analysis

Jou-Hua Wang
1   Department of Orthopedics, National Cheng Kung University, Tainan, Taiwan
,
Hsuan-Hsiao Ma
2   Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
3   Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
,
Te-Feng Arthur Chou
2   Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
3   Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
,
Shang-Wen Tsai 
2   Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
3   Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
,
Cheng-Fong Chen
2   Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
3   Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
,
Po-Kuei Wu
2   Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
3   Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
,
Wei-Ming Chen
2   Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
3   Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Abstract

The interspace between popliteal artery and the capsule of posterior knee (iPACK) block was proposed in recent years to relieve posterior knee pain. Since adductor canal block (ACB) and iPACK involve different branches of the sensory nerves, it is theoretically feasible to combine iPACK block and ACB to relief pain after total knee arthroplasty (TKA). We aim to validate the efficacy of adding iPACK block to ACB in the setting of a multimodal pain management protocol following TKA. A comprehensive literature review on Web of Science, Embase, the Cochrane Library, and PubMed was performed. Eight studies (N = 1,056) that compared the efficacy of iPACK block + ACB with ACB alone were included. Primary outcomes consisted of Visual Analogue Scale (VAS) score at rest or during activity at various time points. Secondary outcomes include opioids consumption, walking distance, and length of hospital stay (LOS). Compared to ACB alone, VAS scores at rest (standardized mean difference [SMD]: –1.18; 95% confidence interval [CI]: –2.05 to –0.30) and during activity (SMD: –0.26; 95% CI: –0.49 to –0.03) on the day of surgery were lower in the iPACK block + ACB group. However, the difference did not reach the minimal clinically important difference. Opioids consumption at postoperative 24 hours was lower in the iPACK + ACB group (SMD: –0.295; 95% CI: –0.543 to –0.048). VAS score on postoperative day (POD) 1 and POD2, opioids consumption from 24 to 48 hours, walking distance, and LOS were not different. In conclusion, the addition of iPACK block to ACB in a multimodal pain management protocol can effectively reduce opioids consumption in the early postoperative period. This is a level III, meta-analysis study.

Keywords

adductor canal block - analgesia - iPACK block - multimodal - nerve block - pain - total knee arthroplasty

Supplementary Material



Publication History

Received: 24 November 2020

Accepted: 21 June 2021

Article published online:
02 October 2021

© 2021. Thieme. All rights reserved.

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