Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Orthopaedics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Reg Anesth Pain Med. 2020 Apr;45(4):267-276. doi: 10.1136/rapm-2019-100895. Epub 2020 Feb 4.
An ultrasound-guided anesthetic technique targeting the interspace between the popliteal artery and capsule of the posterior knee (iPACK) can provide posterior knee analgesia with preserved motor function after total knee arthroplasty (TKA). This study compared the peroneal nerve motor-sparing effects of iPACK block and tibial nerve block (TNB) when combined with local infiltration analgesia (LIA) and continuous adductor canal block (CACB).
In this study, 105 patients scheduled for elective TKA were randomized to receive proximal iPACK block (iPACK1), distal iPACK block (iPACK2), or TNB, along with spinal anesthesia, modified LIA, and CACB. The primary outcome was the incidence of common peroneal nerve (CPN) motor blockade. Secondary outcomes included CPN sensory function, tibial sensorimotor function, posterior knee pain, pain score, intravenous morphine requirement, timed up-and-go test, quadriceps muscle strength, range of motion, length of hospital stay, patient satisfaction, and adverse events.
The incidence of CPN motor blockade was significantly higher in the TNB group than in the iPACK1 (p=0.001) and iPACK2 (p=0.001) groups, but was not significant between the iPACK1 and iPACK2 groups (p0.76). Tibial nerve motor function was more preserved in the iPACK1 and iPACK2 groups than in the TNB group (p<0.001 and p<0.001, respectively). Complete CPN and tibial sensorimotor blockade were not observed in the iPACK2 group. Posterior knee pain score was significantly higher in the iPACK1 group than in other groups during the 24-hour postoperative period (p=0.001).
Compared with TNB, iPACK1 and iPACK2 preserved CPN and tibial nerve motor function to a greater extent. However, iPACK2 did not demonstrate complete CPN and tibial nerve motor blockade while maintaining effective posterior knee pain relief.
TCTR20180206002.
超声引导下腘窝动脉与膝关节囊间隙（iPACK）阻滞可用于全膝关节置换术（TKA）后提供膝关节后侧镇痛并保留运动功能。本研究比较了 iPACK 阻滞联合局部浸润镇痛（LIA）和连续收肌管阻滞（CACB）与胫神经阻滞（TNB）对腓总神经的保护作用。
本研究纳入 105 例行择期 TKA 的患者，随机分为接受近端 iPACK 阻滞（iPACK1）、远端 iPACK 阻滞（iPACK2）或 TNB 联合椎管内麻醉、改良 LIA 和 CACB。主要结局为腓总神经（CPN）运动阻滞的发生率。次要结局包括 CPN 感觉功能、胫神经感觉运动功能、膝关节后侧疼痛、疼痛评分、静脉吗啡需求、计时起立行走测试、股四头肌肌力、关节活动度、住院时间、患者满意度和不良事件。
TNB 组 CPN 运动阻滞的发生率明显高于 iPACK1 组（p=0.001）和 iPACK2 组（p=0.001），但 iPACK1 组和 iPACK2 组之间无显著差异（p=0.76）。iPACK1 组和 iPACK2 组的胫神经运动功能保留较 TNB 组更显著（p<0.001 和 p<0.001）。iPACK2 组未出现完全的 CPN 和胫神经感觉运动阻滞。术后 24 小时内，iPACK1 组的膝关节后侧疼痛评分明显高于其他组（p=0.001）。
与 TNB 相比，iPACK1 和 iPACK2 更能保留 CPN 和胫神经运动功能。然而，iPACK2 虽然能有效缓解膝关节后侧疼痛，但并未完全阻断 CPN 和胫神经运动功能。
TCTR20180206002。
