Clinical Impact of IPACK Block Addition to Suprainguinal Fascia Iliaca Block

Clinical Impact of IPACK Block Addition to Suprainguinal Fascia Iliaca Block in Knee Arthroplasty Patients Under Spinal Anesthesia: A Retrospective Cohort Study

In our clinic, routine suprainguinal fascia iliaca block (SIFIB) has been administered for postoperative analgesia in patients undergoing knee arthroplasty. Recently, we have introduced the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block to this regimen, and the aim of this retrospective study is to determine whether the addition of the IPACK block enhances the quality of analgesia.

Knee arthroplasty, also known as knee joint replacement surgery, is a common procedure performed to alleviate pain and improve joint function in patients with knee osteoarthritis or other knee-related conditions. Postoperative pain management is crucial for patient comfort and overall recovery.

In this study, we aimed to compare the two techniques mentioned earlier, namely the SIFIB (Suprainguinal Fascia Iliaca Block) and the SIFIB+IPACK, by examining the data of patients who underwent knee arthroplasty under spinal anesthesia at our clinic between January 1, 2023, and September 1, 2023.

Study Overview

• Status: Completed
• Conditions: Analgesia; Acute Pain; Pain Management
• Intervention / Treatment: Procedure: SIFIB (suprainguinal fascia iliaca block); Device: Patient controlled anagesia device; Other: IPACK (Interspace between the popliteal artery and capsule of the posterior knee )

Detailed Description

The knee's nerve supply is intricately derived from branches originating from both the sacral plexus and lumbar plexus, as highlighted in previous studies. Nerves responsible for innervating the surgical field include the femoral nerve (FN), obturator nerve (ON), sciatic nerve (SN), and the lateral femoral cutaneous nerve (LFCN), which is a non-incisional source of pain resulting from tissue manipulation and tourniquet use. These nerves represent potential targets for perioperative pain management strategies. In addition to these nerves, there is ongoing research concerning infiltration techniques specifically targeting the posterior knee capsule, known as the Infiltration of the Posterior Capsule of the Knee (IPACK), which has been elucidated and continues to be a subject of investigation.

• Study Type: Observational
• Enrollment (Actual): 88

Contacts and Locations

Study Locations

• Turkey
  • Samsun, Turkey
    • Samsun University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

data of patients underwent total knee arthroplasty under spinal anesthesia between 01.01.2023 and 01.09.2023

Description

Inclusion Criteria:

• Patients meeting the following criteria and whose postoperative follow-up forms were completed in full were included in the study
• Patients underwent total knee arthroplasty (TKA)
• ASA class I to III.
• operated under spinal anesthesia
• patient controlled analjgesia device was used for analgesia

Exclusion Criteria:

Patients whose data were inaccessible or had incomplete follow-up forms were excluded from the study to ensure the accuracy and reliability of our analysis.

• PCA device problems in follow up in 24 hours
• anesthesia plans were converted to general anesthesia
• spinal anesthesia failure
• peripheral blocks used other than protocol

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
SIFIB; Patients who underwent SIFIB in knee arthroplasty patients under spinal anesthesia will be evaluated retrospectively in terms of opioid consumption and NRS scores.	Procedure: SIFIB (suprainguinal fascia iliaca block); Ultrasound guided Suprainguinal Fascia Iliaca Block for Knee Arthroplasty Patients; Device: Patient controlled anagesia device; Those who were administered opioids with PCA as rescue analgesic in the postoperative analgesia plan on the selected dates will be included in the study.; Other Names: PCA
SIFIB+IPACK; Patients who underwent SIFIB+IPACK blocks in knee arthroplasty patients under spinal anesthesia will be evaluated retrospectively in terms of opioid consumption and NRS scores.	Procedure: SIFIB (suprainguinal fascia iliaca block); Ultrasound guided Suprainguinal Fascia Iliaca Block for Knee Arthroplasty Patients; Device: Patient controlled anagesia device; Those who were administered opioids with PCA as rescue analgesic in the postoperative analgesia plan on the selected dates will be included in the study.; Other Names: PCA; Other: IPACK (Interspace between the popliteal artery and capsule of the posterior knee ); Ultrasound guided IPACK (Interspace between the popliteal artery and capsule of the posterior knee ) Block for Knee Arthroplasty Patients

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Opioid consumption	Opioid consumption via PCA device	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NRS scores	NRS scores in different time frames. In a Numerical Rating Scale (NRS), patients are asked to circle the number between 0 and 10, that fits best to their pain intensity. Zero usually represents 'no pain at all' whereas the upper limit represents 'the worst pain ever possible'.	24 hours

Collaborators and Investigators

• Sponsor: Samsun University
• Investigators: Principal Investigator: Hatice Kusderci, M.D., Samsun University

Study record dates

Study Major Dates

• Study Start (Actual): September 3, 2023
• Primary Completion (Actual): September 15, 2023
• Study Completion (Actual): September 15, 2023

Study Registration Dates

• First Submitted: September 15, 2023
• First Submitted That Met QC Criteria: September 22, 2023
• First Posted (Actual): September 26, 2023

Study Record Updates

• Last Update Posted (Actual): September 29, 2023
• Last Update Submitted That Met QC Criteria: September 27, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Keywords: analgesia; IPACK; SIFIB
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Acute Pain
• Other Study ID Numbers: SIFIB+IPACK

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No