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一项尸体研究,调查新生儿样本中腘动脉与后膝阻滞囊之间间隙注射后注射液的扩散情况:一项初步研究。

A cadaveric study investigating the spread of injectate following an interspace between the popliteal artery and the capsule of the posterior knee block in a neonatal sample: a pilot study.

作者信息

Govender-Davies Sabashnee, Davies Llewellyn, Pillay-Addinall Sashrika

机构信息

Department of Anatomy and Histology, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.

Department of Anaesthesia, Steve Biko Academic Hospital, Pretoria, South Africa.

出版信息

Anat Cell Biol. 2024 Jun 30;57(2):229-237. doi: 10.5115/acb.23.274. Epub 2024 Mar 29.


DOI:10.5115/acb.23.274
PMID:38551026
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11184435/
Abstract

The infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block, is a novel ultrasound-guided technique used for postoperative pain management of the knee. The success of the block is attributed to the spread of injectate between the capsule of the knee and the popliteal artery. This novel technique is believed to target the articular branches of the tibial, common fibular (peroneal) and obturator nerves. However, the extent of the spread in a paediatric population is unknown. Therefore, this study aims to evaluate the spread of the IPACK block. Using ultrasound guidance, the IPACK block was replicated bilaterally in neonatal cadavers. Methylene blue dye (0.3 ml/kg) was injected proximally and distally. Subsequently, cadavers were dissected to determine the injectate spread. Proximal injections resulted in staining of some of the articular branches, while the distal injections resulted in staining of all four articular branches. Additional staining of the superior lateral and medial genicular nerves was noted irrespective of the technique. Overall, both injections resulted in posterior, anterolateral spread with limited medial spread. Results from this study reveal preservation of the main nerve trunks following the proximal technique, while the distal technique displayed greater staining of the articular branches. We believe that the block can be seen as a more holistic and viable alternative to lower limb blocks for the paediatric population, as it allows for a wider spread in the posterior and medial-lateral compartments of the knee.

摘要

腘动脉与后膝关节囊间隙(IPACK)阻滞是一种用于膝关节术后疼痛管理的新型超声引导技术。该阻滞的成功归因于注射剂在膝关节囊与腘动脉之间的扩散。这种新技术被认为是针对胫神经、腓总神经(腓神经)和闭孔神经的关节支。然而,在儿科人群中其扩散范围尚不清楚。因此,本研究旨在评估IPACK阻滞的扩散情况。在超声引导下,在新生儿尸体上双侧复制IPACK阻滞。在近端和远端注射亚甲蓝染料(0.3 ml/kg)。随后,解剖尸体以确定注射剂的扩散情况。近端注射导致一些关节支染色,而远端注射导致所有四个关节支染色。无论采用何种技术,均发现膝上外侧和内侧神经有额外染色。总体而言,两种注射均导致向后、前外侧扩散,内侧扩散有限。本研究结果显示,近端技术后主要神经干得以保留,而远端技术显示关节支染色更多。我们认为,对于儿科人群,该阻滞可被视为下肢阻滞更全面、可行的替代方法,因为它能在膝关节的后内侧和外侧间隙实现更广泛的扩散。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/b146fa7a0547/acb-57-2-229-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/4fec42a16afb/acb-57-2-229-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/44a871f4a9a8/acb-57-2-229-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/fd0af2295d4f/acb-57-2-229-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/1976387d07c2/acb-57-2-229-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/b146fa7a0547/acb-57-2-229-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/4fec42a16afb/acb-57-2-229-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/44a871f4a9a8/acb-57-2-229-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/fd0af2295d4f/acb-57-2-229-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/1976387d07c2/acb-57-2-229-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1071/11184435/b146fa7a0547/acb-57-2-229-f5.jpg

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A cadaveric study investigating the spread of injectate following an interspace between the popliteal artery and the capsule of the posterior knee block in a neonatal sample: a pilot study.

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[7]
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[8]
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引用本文的文献

[1]
Enhanced Postoperative Pain Management and Mobility Following Arthroscopic Knee Surgery: A Comparative Study of Adductor Canal Block with and without IPACK Block.

Med Sci Monit. 2024-7-28

本文引用的文献

[1]
IPACK and genicular nerves block: which nerves are we targeting?

Reg Anesth Pain Med. 2022-3

[2]
Novel lateral approach for ultrasound-guided IPACK block.

Anaesth Crit Care Pain Med. 2021-6

[3]
The anatomical features of an ultrasound-guided erector spinae fascial plane block in a cadaveric neonatal sample.

Paediatr Anaesth. 2020-11

[4]
Analgesic efficacy of adding the IPACK block to a multimodal analgesia protocol for primary total knee arthroplasty.

Reg Anesth Pain Med. 2020-10

[5]
Knee orthopedic problems in newborns and infancy: a review.

Curr Opin Pediatr. 2020-2

[6]
Infiltration Between Popliteal Artery and Capsule of the Knee Block to Augment Continuous Femoral Nerve Catheter for Adolescent Anterior Cruciate Ligament Reconstruction: A Case Series.

A A Pract. 2020-1-15

[7]
Ambulatory knee replacements with IPACK block.

J Clin Anesth. 2020-3

[8]
Evaluation of the iPACK block injectate spread: a cadaveric study.

Reg Anesth Pain Med. 2019-5-6

[9]
Optimal location of local anesthetic injection in the interspace between the popliteal artery and posterior capsule of the knee (iPACK) for posterior knee pain after total knee arthroplasty: an anatomical and clinical study.

Korean J Anesthesiol. 2019-4-30

[10]
Use of IPACK block with continuous femoral triangle block for total knee arthroplasty: A clinical experience.

J Clin Anesth. 2019-5

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