Optimization of regional analgesia after total knee arthroplasty based on ipack-block

Abstract

AIM: To study the efficacy and safety of a combination of the IPACK and the adductor canal blocks (ACB) and compare with the femoral nerve block after total knee arthroplasty (TKA).
 MATERIALS AND METHODS: Double-blind, prospective, randomized, controlled trial with 101 patients. Three groups were distinguished, differing in the chosen method of regional anesthesia. Group 1 included patients with a combination of afferent canal block and IPACK block, group 2 included patients with femoral nerve block, and group 3 included patients with femoral nerve block and IPACK block. Pain at rest and during movement, the need for opioid analgesics in the postoperative period, and the possibility of early activation of patients after knee arthroplasty were assessed on a visual analog scale. The incidence of side effects associated with regional anesthesia was also noted.
 RESULTS: The study showed that the combination of adductor canal blockade and IPACK blockade showed the best effectiveness of pain syndrome control. Patients were less likely to need narcotic analgesics, there was no development of motor block and, as a result, patients were more satisfied with anesthesia. The combination of blockades made it possible to accelerate the rehabilitation of patients in the postoperative period, due to a decrease in pain and the absence of a motor block.
 CONCLUSIONS: The use of IPACK blockade in combination with adductor canal blockade provides effective analgesia and reduces the use of analgesics, as well as increases the patient's rehabilitation potential.