School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, 70119, USA.
Curr Pain Headache Rep. 2024 Jul;28(7):673-679. doi: 10.1007/s11916-024-01237-3. Epub 2024 Mar 23.
Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as it is designed to inhibit nerve branches innervating this area. In this article, we examine the rationale behind the IPACK procedure, how it is performed, and clinical trials examining its efficacy.
5 of the 7 clinical trials examined in this article showed the IPACK + ACB block to show superior efficacy in treating pain following TKR compared to other blocks. These blocks included PMDI+ACB, SPANK+ACB, PAI+ACB, ACB alone, and SCAB. 2 of the 7 clinical trials showed the IPACK + ACB to be less effective in managing patients pain following TKR compared to other blocks which included the CACB and 4 in 1 block. In most instances, the IPACK + ACB showed superior efficacy in managing patients' pain following TKR when compared to other types of nerve blocks. This was determined by measuring usage of opioids, reported postoperative pain, and length of hospital stays following TKR. Thus, we suppose the IPACK block may be used in conjunction with the ACB to effectively reduce patient's pain following TKR.
全膝关节置换（TKR）后，患者常经历明显程度的膝关节疼痛。为缓解疼痛，可以施行神经阻滞，如收肌管阻滞（ACB）。然而，ACB 无法缓解膝关节后部区域的疼痛。一种新的神经阻滞技术即 IPACK 阻滞，可能与 ACB 联合使用，因为它旨在抑制支配该区域的神经分支。本文探讨了 IPACK 操作背后的原理、实施方法以及评估其疗效的临床试验。
本文综述的 7 项临床试验中的 5 项表明，与其他阻滞方法相比，IPACK+ACB 阻滞在治疗 TKR 后疼痛方面更有效。这些阻滞方法包括 PMDI+ACB、SPANK+ACB、PAI+ACB、ACB 单独阻滞和 SCAB。7 项临床试验中的 2 项表明，与其他阻滞方法（包括 CACB 和 4-in-1 阻滞）相比，IPACK+ACB 阻滞在管理 TKR 后患者疼痛方面效果较差。在大多数情况下，与其他类型的神经阻滞相比，IPACK+ACB 阻滞在管理 TKR 后患者疼痛方面更有效。这是通过测量阿片类药物的使用、术后报告的疼痛以及 TKR 后的住院时间来确定的。因此，我们假设 IPACK 阻滞可以与 ACB 联合使用，以有效减轻 TKR 后患者的疼痛。
