Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement

Autor: Pier Francesco Indelli, Oluwatobi O Hunter, Rachel R. Wang, Alex Kou, Edward R. Mariano, T. Edward Kim, Sanjay K. Sinha, Brandon Kandarian
Rok vydání: 2019
Předmět:
Male
total knee arthroplasty
medicine.medical_specialty
Knee Joint
Adductor canal
Analgesic
local infiltration analgesia
Cohort Studies
lcsh:RD78.3-87.3
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
medicine.artery
Anesthesiology
Humans
Pain Management
Medicine
Popliteal Artery
multimodal analgesia
Arthroplasty
Replacement
Knee
implementation
Adverse effect
Ultrasonography
Interventional
Aged
Pain Measurement
Retrospective Studies
Pain
Postoperative
Clinical Research Article
business.industry
Capsule
030208 emergency & critical care medicine
Retrospective cohort study
adductor canal catheter
Middle Aged
Institutional review board
Popliteal artery
Analgesics
Opioid
Treatment Outcome
Anesthesiology and Pain Medicine
medicine.anatomical_structure
ipack
lcsh:Anesthesiology
Anesthesia
Female
Analgesia
business
Joint Capsule
Anesthesia
Local
Zdroj: Korean Journal of Anesthesiology, Vol 72, Iss 3, Pp 238-244 (2019)
Korean Journal of Anesthesiology
ISSN: 2005-7563
2005-6419
Popis: Background The Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block is a new anesthesiologist- administered analgesic technique for controlling posterior knee pain that has not yet been well studied in total knee arthroplasty (TKA) patients. We compared pain outcomes in TKA patients before and after implementation of the IPACK with the hypothesis that patients receiving IPACK blocks will report lower pain scores on postoperative day (POD) 0 than non-IPACK patients. Methods With Institutional Review Board approval, we retrospectively reviewed data for consecutive TKA patients by a single surgeon 4 months before (PRE) and after (POST) IPACK implementation. All TKA patients received adductor canal catheters and peri-operative multimodal analgesia. The primary outcome was pain on POD 0. Other outcomes were daily pain scores, opioid consumption, ambulation distance, length of stay, and adverse events within 30 days. Results Post-implementation, 48/50 (96%) of TKA patients received an IPACK block, and they were compared with 32 patients in the PRE group. On POD 0, the lowest pain score (median [10th-90th percentiles]) was significantly lower for the POST group compared to the PRE group (0 [0-4.3] vs. 2.5 [0-7]; P = 0.003). The highest patient-reported pain scores on any POD were similar between groups with no differences in other outcomes. Conclusions Within a multimodal analgesic protocol, addition of IPACK blocks decreased the lowest pain scores on POD 0. Although other outcomes were unchanged, there may be a role for new opioid-sparing analgesic techniques, and changing clinical practice change can occur rapidly.
Databáze: OpenAIRE
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