Zhao Chengcheng, Wang Qiuru, Cai Lijun, Chen Liyile, Kang Pengde
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
HSS J. 2025 Feb;21(1):73-80. doi: 10.1177/15563316231201126. Epub 2023 Oct 23.
There is no consensus on whether adductor canal block (ACB) combined with infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can further increase analgesia and reduce opioid consumption after total knee arthroplasty (TKA) compared with ACB and periarticular infiltration analgesia (PIA).
This study aimed to evaluate the effectiveness of combining ACB and PACK block on analgesia and functional recovery following TKA.
A retrospective cohort study was conducted involving 386 patients who underwent primary unilateral TKA at our institution from January 2020 to October 2022. Patients were divided into 3 groups and treated with PIA, ACB, or ACB combined with IPACK block, respectively. Primary outcomes were postoperative morphine consumption and visual analogue scale (VAS) pain scores. Secondary outcomes included functional recovery, evaluated by knee range of motion, quadriceps strength, daily mobilization distance, and postoperative length of stay. Other outcomes included incidence of complications.
Patients in the ACB + IPACK group had significantly less morphine consumption on postoperative day 1 and during hospitalization than patients in the PIA and ACB groups. Furthermore, the ACB + IPACK group had significantly lower VAS scores at rest and during motion at 6, 12, and 24 hours postoperatively (but not at other time points), better knee range of motion on postoperative days 1 and 2 (but not day 3), and a greater daily mobilization distance on postoperative day 1 (but not days 2 and 3). The ACB + IPACK group had significantly lower incidences of postoperative nausea and vomiting than the PIA and ACB groups.
This retrospective cohort study suggests that a combination of ACB and IPACK block may have a greater effect than PIA or ACB alone on analgesia following TKA, while providing better functional recovery. Further study is warranted.
与收肌管阻滞（ACB）和关节周围浸润镇痛（PIA）相比，收肌管阻滞联合腘动脉与后膝关节囊间浸润（IPACK）阻滞在全膝关节置换术（TKA）后是否能进一步增强镇痛效果并减少阿片类药物用量，目前尚无定论。
本研究旨在评估ACB与IPACK阻滞联合应用对TKA后镇痛及功能恢复的有效性。
进行一项回顾性队列研究，纳入2020年1月至2022年10月在本机构接受初次单侧TKA的386例患者。患者分为3组，分别接受PIA、ACB或ACB联合IPACK阻滞治疗。主要结局指标为术后吗啡用量和视觉模拟评分（VAS）疼痛评分。次要结局指标包括功能恢复情况，通过膝关节活动范围、股四头肌力量、每日活动距离及术后住院时间进行评估。其他结局指标包括并发症发生率。
ACB + IPACK组患者术后第1天及住院期间的吗啡用量显著少于PIA组和ACB组患者。此外，ACB + IPACK组在术后6、12和24小时静息及活动时的VAS评分显著更低（但其他时间点无差异），术后第1天和第2天膝关节活动范围更好（第3天无差异），术后第1天每日活动距离更远（第2天和第3天无差异）。ACB + IPACK组术后恶心呕吐的发生率显著低于PIA组和ACB组。
这项回顾性队列研究表明，ACB与IPACK阻滞联合应用在TKA后的镇痛效果可能优于单独使用PIA或ACB，同时能带来更好的功能恢复。有必要进一步研究。
