Department of Orthopedics, National Cheng Kung University, Tainan, Taiwan.
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
J Knee Surg. 2023 Mar;36(4):345-353. doi: 10.1055/s-0041-1733882. Epub 2021 Oct 2.
The interspace between popliteal artery and the capsule of posterior knee (iPACK) block was proposed in recent years to relieve posterior knee pain. Since adductor canal block (ACB) and iPACK involve different branches of the sensory nerves, it is theoretically feasible to combine iPACK block and ACB to relief pain after total knee arthroplasty (TKA). We aim to validate the efficacy of adding iPACK block to ACB in the setting of a multimodal pain management protocol following TKA. A comprehensive literature review on Web of Science, Embase, the Cochrane Library, and PubMed was performed. Eight studies ( = 1,056) that compared the efficacy of iPACK block + ACB with ACB alone were included. Primary outcomes consisted of Visual Analogue Scale (VAS) score at rest or during activity at various time points. Secondary outcomes include opioids consumption, walking distance, and length of hospital stay (LOS). Compared to ACB alone, VAS scores at rest (standardized mean difference [SMD]: -1.18; 95% confidence interval [CI]: -2.05 to -0.30) and during activity (SMD: -0.26; 95% CI: -0.49 to -0.03) on the day of surgery were lower in the iPACK block + ACB group. However, the difference did not reach the minimal clinically important difference. Opioids consumption at postoperative 24 hours was lower in the iPACK + ACB group (SMD: -0.295; 95% CI: -0.543 to -0.048). VAS score on postoperative day (POD) 1 and POD2, opioids consumption from 24 to 48 hours, walking distance, and LOS were not different. In conclusion, the addition of iPACK block to ACB in a multimodal pain management protocol can effectively reduce opioids consumption in the early postoperative period. This is a level III, meta-analysis study.
近年来，人们提出了在腘动脉和后膝关节囊（iPACK）之间的间隙进行阻滞以缓解后膝关节疼痛。由于收肌管阻滞（ACB）和 iPACK 涉及感觉神经的不同分支，因此在多模式疼痛管理方案中联合使用 iPACK 阻滞和 ACB 来缓解全膝关节置换术后（TKA）的疼痛在理论上是可行的。我们旨在验证在 TKA 后多模式疼痛管理方案中添加 iPACK 阻滞对 ACB 的疗效。我们在 Web of Science、Embase、Cochrane 图书馆和 PubMed 上进行了全面的文献复习。纳入了 8 项（n=1056）比较 iPACK 阻滞+ACB 与单独 ACB 疗效的研究。主要结局包括不同时间点静息或活动时的视觉模拟量表（VAS）评分。次要结局包括阿片类药物消耗量、行走距离和住院时间（LOS）。与单独 ACB 相比，iPACK 阻滞+ACB 组在手术当天的静息时（标准化均数差 [SMD]：-1.18；95%置信区间 [CI]：-2.05 至 -0.30）和活动时（SMD：-0.26；95% CI：-0.49 至 -0.03）的 VAS 评分较低。然而，这一差异并未达到最小临床重要差异。iPACK 阻滞+ACB 组术后 24 小时阿片类药物消耗量较低（SMD：-0.295；95% CI：-0.543 至 -0.048）。术后第 1 天和第 2 天的 VAS 评分、术后 24 至 48 小时的阿片类药物消耗量、行走距离和 LOS 无差异。总之，在多模式疼痛管理方案中，将 iPACK 阻滞加入 ACB 可有效减少术后早期阿片类药物的消耗。这是一项 III 级荟萃分析研究。
