Abstract
BackgroundThe aim of this study is to compare the postoperative analgesic effect of infiltration between the popliteal artery and the capsule of the knee (IPACK) and the effect of periarticular multimodal drug injection (PMDI) in addition to adductor canal block (ACB) after total knee arthroplasty.MethodsAmong patients who received total knee arthroplasty from June 2017 to December 2017, 50 who underwent ACB with additional IPACK and 50 who received ACB with additional PMDI were selected for this study. We compared the postoperative pain numerical rating scale (NRS), the number of times patient-controlled analgesia was administered and the amount administered, the total amount of opioids given, and complications associated with the procedure between the two groups.ResultsNRS measured at rest and 45° knee flexion at days 1 and 2 after surgery was significantly lower in the IPACK group than in the PMDI group. The resting NRS measured at day 3 after surgery was also significantly lower in the IPACK group than in the PMDI group, and the NRS at 45° knee flexion measured from day 3 to day 5 showed a significant reduction in the IPACK group. No complications relating to the procedure occurred.ConclusionsIPACK may be a better option than PMDI for controlling acute phase pain in patients undergoing total knee arthroplasty.
Highlights
Total knee arthroplasty is satisfactory for improving pain and recovery from arthritis, but many patients complain of postoperative pain [1, 2]
Study design This study was approved by the Institutional Review Board (IRB) of Bumin Hospital (IRB 201905-BM-003)., Among patients who had undergone total knee arthroplasty by a single surgeon for degenerative arthritis of the knee from June to December 2017, 92 patients underwent IPACK and 121 patients underwent periarticular multimodal drug injection (PMDI) (Fig. 1)
Since patients can press the patient-controlled analgesia button regardless of the pain caused by a tourniquet or postoperative pain arising from any part of the knee, it is not appropriate to question the effectiveness of IPACK just because the patient-controlled analgesia button is pressed more times
Summary
Total knee arthroplasty is satisfactory for improving pain and recovery from arthritis, but many patients complain of postoperative pain [1, 2]. Peripheral nerve blocks such as femoral nerve block (FNB), adductor canal block (ACB), and sciatic nerve block have been used to control pain after total knee arthroplasty [7,8,9]. A procedure using ultrasoundguided local anesthetic infiltration between the popliteal artery and the capsule of the knee (IPACK) has been shown to provide significant posterior knee analgesia without affecting the common peroneal nerve [12]. There is no comparative study between IPACK and PMDI on postoperative pain control after total knee arthroplasty in Korean patients. The aim of this study is to compare the postoperative analgesic effect of infiltration between the popliteal artery and the capsule of the knee (IPACK) and the effect of periarticular multimodal drug injection (PMDI) in addition to adductor canal block (ACB) after total knee arthroplasty
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