The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty

Fang-Yu Zheng, Yong-Bo Liu, Hui Huang, Shuai Xu, Xiao-Jun Ma, Ying-Zhi Liu, Hai-Chen Chu, Fang-Yu Zheng, Yong-Bo Liu, Hui Huang, Shuai Xu, Xiao-Jun Ma, Ying-Zhi Liu, Hai-Chen Chu

Abstract

Background: This study aimed to evaluate the impact of Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) combined with an adductor canal block under the guidance of ultrasound on early motor function after Total Knee Arthroplasty (TKA).

Methods: A sample of 60 cases who were scheduled for elective unilateral TKA were divided into two groups using random number table method: a group with IPACK combined with an adductor canal block (I group, n = 30), and a group with femoral nerve block combined with superior popliteal sciatic nerve block (FS group, n = 30). Before anesthesia induction was completed, the patients in I group received an ultrasound-guided adductor canal block with 15 mL of 0.375% ropivacaine and an IPACK block with 25 mL of ropivacaine, and the patients in FS group received a femoral nerve block and a superior popliteal sciatic nerve block with 20 mL of 0.375% ropivacaine under ultrasound guidance. Post-operation, all the patients received patient-controlled intravenous analgesia combined with an oral celecoxib capsule to relieve pain and maintain a visual analogue scale score of ≤ 3.

Results: The quadriceps femoris muscle strength score was significantly higher in Ⅰ group than in FS group (p = 0.001), while the modified Bromage score were significantly lower and walking distance results were significantly higher in Ⅰ group than in FS group (both p = 0.000).

Conclusion: Compared with femoral nerve block combined with superior popliteal sciatic nerve block, IPACK combined with adductor canal block had a mild impact on early motor functions after TKA.

Keywords: Adductor canal block; IPACK; Peripheral nerve blocks; Regional anesthesia; Total knee arthroplasty.

Copyright © 2021. Published by Elsevier Editora Ltda.

Figures

Figure 1
Figure 1
Comparison of Quadriceps muscle strength score (***, p = 0.001). PACU, when leave the Postoperative Anesthesia Care Unit; MMT score, Manual Muscle Test score (★★: p < 0.001).
Figure 2
Figure 2
Comparison of Bromage score. PACU: when leave the Postoperative Anesthesia Care Unit (●: p < 0.05; ★: p < 0.05; ★★: p < 0.001).
Figure 3
Figure 3
Comparison of postoperative walking distance (●: p < 0.05; ★: p < 0.05).

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