Sichuan University/Department of Orthopedics, Sichuan University, West China Hospital, West China School of Nursing, Chengdu, People's Republic of China.
Department of Orthopedics, Sichuan University, Orthopedic Research Institute, West China Hospital, Chengdu, People's Republic of China.
J Arthroplasty. 2023 Aug;38(8):1484-1492. doi: 10.1016/j.arth.2023.01.010. Epub 2023 Jan 20.
Local infiltration analgesia (LIA) is a popular analgesic technique commonly administered during total knee arthroplasty (TKA). Recent studies have demonstrated that the infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) can be complementary to analgesic modalities. However, the combined and relative efficacy of LIA and IPACK is unclear. We aimed to evaluate the analgesic and functional outcomes among LIA, IPACK, and LIA + IPACK.
A total of 120 patients undergoing primary TKA were randomly allocated to 1 of 3 groups: LIA (50 mL of 0.25% ropivacaine and 2.0 μg/mL epinephrine); IPACK (20 mL of 0.25% ropivacaine and 2.0 μg/mL epinephrine); and LIA + IPACK. The primary outcome was the visual analog scale (VAS) pain score. Secondary outcomes were opioid use, knee range of motion (ROM), quadriceps muscle strength, mobilization distance, timed up and go (TUG) test, and postoperative complications.
The mean VAS pain scores were significantly higher after using IPACK alone than after using LIA + IPACK and LIA within 24 hours (all P＜.05). LIA + IPACK had lower mean VAS pain scores than LIA when the knees were at rest (within 12 hours, P < .05) and flexion (within 8 hours, P＜.05). Patients receiving LIA + IPACK and LIA had significantly lower morphine equivalents (ME) than those receiving IPACK alone within 24 hours (26.3, 28.9 versus 47.8, both P＜.05) and during hospitalization (98, 101.6, versus 128.4 both P＜.05). Both LIA + IPACK and LIA had higher ROM (within 2 days), higher level of muscle strength (within 12 hours), longer mobilization distances (within 1 day), and shorter TUG time (till discharge) compared with IPACK alone (all P＜.05), while LIA + IPACK only had a higher knee ROM than LIA on the first postoperative day (P＜.05). There was no significant difference in any other outcomes.
This randomized controlled trial demonstrated that there were significantly lower pain scores, less opioid consumption, and better functional results with LIA + IPACK and LIA when compared with IPACK alone, suggesting that IPACK alone was inferior for pain control.
局部浸润镇痛（LIA）是一种常用于全膝关节置换术（TKA）的流行镇痛技术。最近的研究表明，在腘动脉和膝关节后囊之间浸润（IPACK）可以与其他镇痛方式互补。然而，LIA 和 IPACK 的联合和相对疗效尚不清楚。我们旨在评估 LIA、IPACK 和 LIA+IPACK 之间的镇痛和功能结果。
共 120 例接受初次 TKA 的患者被随机分配至 3 组中的 1 组：LIA（50mL0.25%罗哌卡因和 2.0μg/mL 肾上腺素）；IPACK（20mL0.25%罗哌卡因和 2.0μg/mL 肾上腺素）；和 LIA+IPACK。主要结局是视觉模拟评分（VAS）疼痛评分。次要结局是阿片类药物使用、膝关节活动度（ROM）、股四头肌力量、移动距离、计时起立行走（TUG）测试和术后并发症。
单独使用 IPACK 后 24 小时内的 VAS 疼痛评分明显高于 LIA+IPACK 和 LIA（均 P＜.05）。LIA+IPACK 在膝关节休息时（12 小时内，P＜.05）和屈曲时（8 小时内，P＜.05）的 VAS 疼痛评分均低于 LIA。接受 LIA+IPACK 和 LIA 的患者在 24 小时内（26.3、28.9 与 47.8，均 P＜.05）和住院期间（98、101.6 与 128.4，均 P＜.05）的吗啡当量（ME）明显低于单独使用 IPACK。LIA+IPACK 和 LIA 均具有更高的 ROM（2 天内）、更高的肌肉力量水平（12 小时内）、更长的移动距离（1 天内）和更短的 TUG 时间（直至出院）与单独使用 IPACK 相比（均 P＜.05），而 LIA+IPACK 仅在术后第 1 天的膝关节 ROM 高于 LIA（P＜.05）。在其他结果方面没有显著差异。
这项随机对照试验表明，与单独使用 IPACK 相比，LIA+IPACK 和 LIA 的疼痛评分显著降低、阿片类药物使用减少和功能结果更好，提示单独使用 IPACK 在疼痛控制方面效果较差。
