Abouseeda Marwa M, Rashed Mohamed Mohsen, Hussein Mostafa M, Nady Riham F, Ehab Ahmad M
Department of Anesthesia, Intensive Care and Pain Medicine, Faculty of Medicine, Benha University, Benha, Egypt.
Department of Anesthesia, Intensive Care and Pain Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Anesthesiol Res Pract. 2025 May 22;2025:8937826. doi: 10.1155/anrp/8937826. eCollection 2025.
Total knee arthroplasty (TKA) is a surgical intervention that relieves patients experiencing severe pain and joint dysfunction. The aim is to evaluate ultrasound-guided genicular nerve block (GNB) paired with infiltration between the popliteal artery and the capsule of the posterior knee IPACK block in comparison with adductor canal block (ACB) regarding the analgesia effectiveness and postoperative functional outcomes and rehabilitation parameters for TKA. This randomized controlled trial enrolled 50 individuals of both genders with American Society of Anesthesiologists Class I-III, planned for TKA with spinal anesthesia. The patients were randomly allocated into two groups of 25 each. Group A underwent an ultrasound-guided GNB combined with an IPACK block, while Group B received an ACB. The amount of morphine consumed postoperatively during the initial 48 h was the main outcome. Additional outcomes encompassed postoperative knee range of motion (ROM), straight leg raising (SLR), and time up and go (TUG) test. Group A patients exhibited significantly lower pain perception scores at 6 and 12 h ( < 0.001) and lower 48 h morphine dose in comparison to Group B ( < 0.001). Group A had significantly better results in ROM and TUG tests on the first and second days ( < 0.001). No significant difference was observed in patients achieving SLR on Day 1 (=0.999). Overall, Group A had a faster recovery regarding ROM and TUG and better SLR by Day 2. Group A had better satisfaction. In TKA, combined IPACK and GNB offer superior postoperative analgesia, reduced opioid use, and improved functional outcomes compared to ACB. ClinicalTrials.gov identifier: NCT06423339.
全膝关节置换术（TKA）是一种外科手术干预措施，可缓解经历严重疼痛和关节功能障碍的患者的症状。目的是评估超声引导下的膝状神经阻滞（GNB）联合腘动脉与后膝IPACK阻滞囊之间的浸润与内收肌管阻滞（ACB）相比，在TKA的镇痛效果、术后功能结局和康复参数方面的情况。这项随机对照试验纳入了50名美国麻醉医师协会I-III级的男女患者，计划接受脊髓麻醉下的TKA手术。患者被随机分为两组，每组25人。A组接受超声引导下的GNB联合IPACK阻滞，而B组接受ACB。术后最初48小时内吗啡的消耗量是主要结局指标。其他结局指标包括术后膝关节活动范围（ROM）、直腿抬高（SLR）和计时起立行走（TUG）测试。与B组相比，A组患者在6小时和12小时时的疼痛感知评分显著更低（<0.001），48小时吗啡剂量也更低（<0.001）。A组在第一天和第二天的ROM和TUG测试中结果显著更好（<0.001）。在第一天实现SLR的患者中未观察到显著差异（P=0.999）。总体而言，A组在ROM和TUG方面恢复更快，到第二天SLR更好。A组满意度更高。在TKA中，与ACB相比，IPACK和GNB联合使用可提供更优的术后镇痛、减少阿片类药物使用并改善功能结局。ClinicalTrials.gov标识符：NCT06423339。
