A comparative study of adductor canal block with infiltration of the interspace between popliteal artery and the capsule of posterior knee or with periarticular infiltration after total knee arthroplasty

Abstract

Background & objective: Appropriate perioperative pain management, with multimodal analgesia regimens combining regional anesthesia and systemic analgesics, is crucial for optimum results in individuals undergoing total knee arthroplasty (TKA). We evaluated the efficacy of combined Adductor Canal Block (ACB) and infiltration in the interspace between the popliteal artery and capsule of the knee (IPACK) supplementing against ACB and Periarticular Infiltration (PAI) on postoperative pain scores, use of opioids, and early physical therapy in patients subjected to TKA under spinal anesthesia (SA). Methodology: In the current prospective, randomized, comparative clinical trial, 40 individuals undergoing TKA were arbitrarily distributed in two groups. Group A comprised of patients undergoing ultrasound-guided ACB plus IPACK block; Group B comprised of patients undergoing ACB plus PAI block at the beginning of the surgical procedure. Results: The ACB + IPACK group exhibited notably lower VAS scores (P < 0.05) compared to the ACB plus PAI group. Group A consumed 67.5 ± 21.6 mg of pethidine over the first 48 h, while Group B consumed 87.5 ± 33.9 mg of pethidine. The range of movement of the knee and walking distance also revealed that the values were considerably higher in Group A compared to Group B. Conclusion: The utilization of both adductor canal block and the interspace between the popliteal artery and the knee capsule provides improved analgesia than adductor canal block and periarticular injection, while preserving the knee joint motor power in the postoperative period. Keywords: Adductor canal block; IPACK; Local anesthetic; Multimodal analgesia; Pain, Postoperative; Arthroplasty Citation: Hassan HA, Elzahaby HM, Elagamy AE, Rashed MM, Hussein MM. A comparative study of adductor canal block with infiltration of the interspace between popliteal artery and the capsule of posterior knee or with periarticular infiltration after total knee arthroplasty. Anaesth. pain intensive care 2024;28(4):620−625; DOI: 10.35975/apic.v28i4.2503 Received: February 10, 2024; Reviewed: March 13, 2024; Accepted: March 18, 2024