Govender-Davies Sabashnee, Davies Llewellyn, Pillay-Addinall Sashrika
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.
Anat Cell Biol. 2024 Jun 30;57(2):229-237. doi: 10.5115/acb.23.274. Epub 2024 Mar 29.
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.
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。
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