Cakmak Mehmet Fevzi, Bayram Serkan, Horoz Levent, Arslan Fatma Nur, Demir Onur Utku, Gürsoy Safa
Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey.
Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Arch Orthop Trauma Surg. 2025 Apr 5;145(1):222. doi: 10.1007/s00402-025-05845-5.
The aim of this study compare the effectiveness of the space between the popliteal artery and the posterior knee capsule (iPACK) and posterior capsule injection (PCI) in patients with primary end stage knee osteoarthritis treated with total knee arthroplasty (TKA).
This was a double-blind, prospective, randomised trial. A total of 195 participants were randomly assigned to one of three groups: Group 1 with an adductor canal block (ACB) plus iPACK. Group 2 with ACB + PCI and a final control group with ACB only. All participants underwent primary total knee arthroplasty. Outcome measures comprised pain assessment using the Visual Analog Scale (VAS) and monitoring opioid analgesic consumption. VAS measurements were taken at the 1st, 6th, 12th, 24th, 48th, and 72nd hours, followed by the 10th day and the 12th week.
Age, sex, BMI and side of surgery were analyzed and no significant differences were found. Groups ACB + iPACK and ACB + PCI exhibited significantly lower VAS scores compared to the control group at 3, 6, and 12 h after surgery, with group ACB + iPACK showing the lowest VAS scores among all groups. No significant difference in VAS values between groups was detected after 24 h postoperatively and after that. Significant differences were observed between groups in opioid consumption. The values for the first hour, first day, second day, and total consumption exhibited statistically significant differences between the groups.
Our study has shown that PCI in combination with ACB is not inferior to the iPACK technique. It is our belief that these combination techniques can be used in accordance with the surgeon's experience and preference. It is important to remember that PCI is quicker and easier to perform without using ultrasonography.
本研究旨在比较全膝关节置换术（TKA）治疗原发性终末期膝骨关节炎患者时，腘动脉与后膝囊间隙注射（iPACK）和后囊注射（PCI）的有效性。
这是一项双盲、前瞻性、随机试验。总共195名参与者被随机分配到三组中的一组：第1组接受内收肌管阻滞（ACB）加iPACK；第2组接受ACB + PCI，最后一组为仅接受ACB的对照组。所有参与者均接受初次全膝关节置换术。结局指标包括使用视觉模拟量表（VAS）进行疼痛评估以及监测阿片类镇痛药的消耗量。在第1、6、12、24、48和72小时进行VAS测量，随后在第10天和第12周进行测量。
对年龄、性别、体重指数和手术侧别进行分析，未发现显著差异。与对照组相比，ACB + iPACK组和ACB + PCI组在术后3、6和12小时的VAS评分显著更低，ACB + iPACK组在所有组中VAS评分最低。术后24小时及之后，各组之间的VAS值未检测到显著差异。在阿片类药物消耗量方面，各组之间观察到显著差异。各组在第1小时、第1天、第2天和总消耗量的值存在统计学显著差异。
我们的研究表明，PCI联合ACB并不逊于iPACK技术。我们认为，这些联合技术可根据外科医生的经验和偏好使用。重要的是要记住，PCI在不使用超声检查的情况下操作更快且更容易。
