Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Anaesthesia, St Vincent's University Hospital, Dublin, Ireland.
Reg Anesth Pain Med. 2021 Sep;46(9):784-805. doi: 10.1136/rapm-2021-102681. Epub 2021 May 14.
The infiltration between the popliteal artery and the capsule of the knee (IPACK) block has been described as an alternative analgesic strategy for knee pain.
Our aim was to perform a narrative review to examine the place and value that the IPACK block has in comparison to and in conjunction with other regional anesthesia modalities.
Following an extensive search of electronic databases, we included anatomical studies, letters, comparative observational studies, and non-randomized and randomized controlled trials that examined the IPACK block in relation to surgery on the knee under general or neuraxial anesthesia.
In all, 35 articles were included. Cadaveric studies demonstrated the potential for injected dye to spread to the nerves responsible for the innervation of the posterior as well as anteromedial and anterolateral aspects of the knee. Of the comparative observational studies (n=15) and non-randomized (n=1) and randomized controlled trials (n=13), 2 and 27 were conducted in the context of anterior cruciate ligament reconstruction and knee replacement surgery, respectively. The role of the IPACK block with each different permutation of regional anesthesia techniques was investigated by a small number of studies. Clinical studies, in the setting of knee replacement surgery, revealed variation in the manner in which the IPACK block was performed, and indicated the possible superiority of distal injection at the level of the femoral condyles for the management of posterior knee pain. Evidence suggested the following: the IPACK block in combination with single shot adductor canal block (ACB) may be beneficial for analgesic and functional outcomes; in conjunction with single shot or continuous ACB, the IPACK block might be superior to local infiltration analgesia (LIA); and functional outcomes may be improved with the supplementation of continuous ACB and LIA with the IPACK block. The IPACK block did not commonly result in the occurrence of foot drop. Relative to tibial nerve block (TNB), the IPACK block reduced the occurrence of foot drop and increased the proportion of patients who were able to be discharged on the third postoperative day.
The IPACK block was potentially complementary to the ACB and might be preferable to the TNB as a motor-sparing regional anesthesia technique in knee surgery. Definitive recommendations were not reached in the presence of the heterogeneous and limited evidence base.
腘动脉与膝关节囊之间的浸润（IPACK）阻滞已被描述为膝关节疼痛的另一种镇痛策略。
我们旨在进行叙述性综述，以检查 IPACK 阻滞与其他区域麻醉方式相比和联合使用的位置和价值。
在对电子数据库进行广泛搜索后，我们纳入了解剖学研究、信件、比较观察性研究以及非随机和随机对照试验，这些研究检查了在全身或脊麻下进行膝关节手术时 IPACK 阻滞与其他区域麻醉方式的关系。
共纳入 35 篇文章。尸体研究表明，注入的染料有可能扩散到负责支配膝关节后、前内侧和前外侧的神经。在比较观察性研究（n=15）和非随机（n=1）和随机对照试验（n=13）中，有 2 项和 27 项分别在前交叉韧带重建和膝关节置换手术中进行。少数研究探讨了 IPACK 阻滞与不同区域麻醉技术组合的作用。在膝关节置换手术的临床研究中，IPACK 阻滞的实施方式存在差异，并表明在股骨髁水平进行远端注射可能更有利于管理膝关节后部疼痛。证据表明：IPACK 阻滞联合单次收肌管阻滞（ACB）可能有利于镇痛和功能结果；与单次或连续 ACB 联合使用，IPACK 阻滞可能优于局部浸润镇痛（LIA）；并且连续 ACB 和 LIA 联合 IPACK 阻滞可能会改善功能结果。IPACK 阻滞通常不会导致足下垂。与胫骨神经阻滞（TNB）相比，IPACK 阻滞降低了足下垂的发生率，并增加了能够在术后第 3 天出院的患者比例。
IPACK 阻滞可能与 ACB 互补，并且作为膝关节手术中的一种运动神经保护区域麻醉技术，可能优于 TNB。在存在异构和有限的证据基础的情况下，没有得出明确的建议。
