Application of infiltration between the popliteal artery and capsule of the knee block in analgesia after total knee arthroplasty_West China Medical Journal

Authors：

ZHAO Shanshan ¹ ,  ZHANG Zongwang ²

1. Department of Postgraduate, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, Shandong 271000, P. R. China;
2. Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, Shandong 252000, P. R. China;

Corresponding author：

ZHANG Zongwang, Email: zongwangzhang@sdu.edu.cn

Keywords：

Infiltration between the popliteal artery and capsule of the knee block; total knee arthroplasty; analgesia

DOI：

10.7507/1002-0179.202005398

Video：

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Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.

Citation： ZHAO Shanshan, ZHANG Zongwang. Application of infiltration between the popliteal artery and capsule of the knee block in analgesia after total knee arthroplasty. West China Medical Journal, 2022, 37(3): 473-476. doi: 10.7507/1002-0179.202005398 Copy

1.	梅轶芳. 中国骨关节炎流行病学研究现状及规范. 中国实用内科杂志, 2019, 39(8): 663-665.
2.	Horst PK, Barrett AA, Huddleston JI 3rd, et al. Total knee arthroplasty has a positive effect on patients with low mental health scores. J Arthroplasty, 2020, 35(1): 112-115.
3.	Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology, 2013, 118(4): 934-944.
4.	Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty. Orthop Surg, 2019, 11(5): 755-761.
5.	Baratta JL, Gandhi K, Viscusi ER. Perioperative pain management for total knee arthroplasty. J Surg Orthop Adv, 2014, 23(1): 22-36.
6.	Chen J, Lesser JB, Hadzic A, et al. Adductor canal block can result in motor block of the quadriceps muscle. Reg Anesth Pain Med, 2014, 39(2): 170-171.
7.	Kuang MJ, Ma JX, Fu L, et al. Is Adductor canal block better than femoral nerve block in primary total knee arthroplasty? A GRADE analysis of the evidence through a systematic review and meta-analysis. J Arthroplasty, 2017, 32(10): 3238-3248.e3.
8.	Perlas A, Kirkham KR, Billing R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med, 2013, 38(4): 334-339.
9.	Sinha SK, Abrams JH, Arumugam S, et al. Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study. Anesth Analg, 2012, 115(1): 202-206.
10.	Horner G, Dellon AL. Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res, 1994(301): 221-226.
11.	Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Curr Pain Headache Rep, 2017, 21(5): 23.
12.	Bendtsen TF, Moriggl B, Chan V, et al. The optimal analgesic block for total knee arthroplasty. Reg Anesth Pain Med, 2016, 41(6): 711-719.
13.	Sinha S. How I do it: infiltration between popliteal artery and capsule of knee (iPACK). (2020-05-03)[2020-05-31]. https://www.asra.com/news-publications/asra-updates/blog-landing/asra-news/2020/05/03/how-i-do-it-infiltration-between-popliteal-artery-and-capsule-of-knee-(ipack).
14.	Thobhani S, Scalercio L, Elliott CE, et al. Novel regional techniques for total knee arthroplasty promote reduced hospital length of stay: an analysis of 106 patients. Ochsner J, 2017, 17(3): 233-238.
15.	Niesen AD, Harris DJ, Johnson CS, et al. Interspace between popliteal artery and posterior capsule of the knee (IPACK) injectate spread: a cadaver study. J Ultrasound Med, 2019, 38(3): 741-745.
16.	Scapinelli R. Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat, 1997, 10(3): 151-162.
17.	Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med, 1982, 10(6): 329-335.
18.	Tran J, Giron Arango L, Peng P, et al. Evaluation of the iPACK block injectate spread: a cadaveric study. Reg Anesth Pain Med, 2019, 6: rapm-2018-100355.
19.	Sankineani SR, Reddy ARC, Eachempati KK, et al. Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol, 2018, 28(7): 1391-1395.
20.	Patterson ME, Vitter J, Bland K, et al. The effect of the IPACK block on pain after primary tka: a double-blinded, prospective, randomized trial. J Arthroplasty, 2020, 35(6S): S173-S177.
21.	Kandarian B, Indelli PF, Sinha S, et al. Implementation of the IPACK (infiltration between the popliteal artery and capsule of the knee) block into a multimodal analgesic pathway for total knee replacement. Korean J Anesthesiol, 2019, 72(3): 238-244.
22.	Ohgoshi Y, Matsutani M, Kubo EN. Use of IPACK block with continuous femoral triangle block for total knee arthroplasty: a clinical experience. J Clin Anesth, 2019, 54: 52-54.
23.	Eccles CJ, Swiergosz AM, Smith AF, et al. Decreased opioid consumption and length of stay using an IPACK and adductor canal nerve block following total knee arthroplasty. J Knee Surg, 2021, 34(7): 705-711.
24.	Kim DH, Beathe JC, Lin Y, et al. Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg, 2019, 129(2): 526-535.
25.	Kampitak W, Tanavalee A, Ngarmukos S, et al. Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia. J Arthroplasty, 2019, 34(2): 295-302.
26.	Kampitak W, Tanavalee A, Ngarmukos S, et al. Motor-sparing effect of iPACK (interspace between the popliteal artery and capsule of the posterior knee) block versus tibial nerve block after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med, 2020, 45(4): 267-276.

1. 梅轶芳. 中国骨关节炎流行病学研究现状及规范. 中国实用内科杂志, 2019, 39(8): 663-665.
2. Horst PK, Barrett AA, Huddleston JI 3rd, et al. Total knee arthroplasty has a positive effect on patients with low mental health scores. J Arthroplasty, 2020, 35(1): 112-115.
3. Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology, 2013, 118(4): 934-944.
4. Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty. Orthop Surg, 2019, 11(5): 755-761.
5. Baratta JL, Gandhi K, Viscusi ER. Perioperative pain management for total knee arthroplasty. J Surg Orthop Adv, 2014, 23(1): 22-36.
6. Chen J, Lesser JB, Hadzic A, et al. Adductor canal block can result in motor block of the quadriceps muscle. Reg Anesth Pain Med, 2014, 39(2): 170-171.
7. Kuang MJ, Ma JX, Fu L, et al. Is Adductor canal block better than femoral nerve block in primary total knee arthroplasty? A GRADE analysis of the evidence through a systematic review and meta-analysis. J Arthroplasty, 2017, 32(10): 3238-3248.e3.
8. Perlas A, Kirkham KR, Billing R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med, 2013, 38(4): 334-339.
9. Sinha SK, Abrams JH, Arumugam S, et al. Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty: a prospective, randomized, observer-blinded study. Anesth Analg, 2012, 115(1): 202-206.
10. Horner G, Dellon AL. Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res, 1994(301): 221-226.
11. Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Curr Pain Headache Rep, 2017, 21(5): 23.
12. Bendtsen TF, Moriggl B, Chan V, et al. The optimal analgesic block for total knee arthroplasty. Reg Anesth Pain Med, 2016, 41(6): 711-719.
13. Sinha S. How I do it: infiltration between popliteal artery and capsule of knee (iPACK). (2020-05-03)[2020-05-31]. https://www.asra.com/news-publications/asra-updates/blog-landing/asra-news/2020/05/03/how-i-do-it-infiltration-between-popliteal-artery-and-capsule-of-knee-(ipack).
14. Thobhani S, Scalercio L, Elliott CE, et al. Novel regional techniques for total knee arthroplasty promote reduced hospital length of stay: an analysis of 106 patients. Ochsner J, 2017, 17(3): 233-238.
15. Niesen AD, Harris DJ, Johnson CS, et al. Interspace between popliteal artery and posterior capsule of the knee (IPACK) injectate spread: a cadaver study. J Ultrasound Med, 2019, 38(3): 741-745.
16. Scapinelli R. Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat, 1997, 10(3): 151-162.
17. Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med, 1982, 10(6): 329-335.
18. Tran J, Giron Arango L, Peng P, et al. Evaluation of the iPACK block injectate spread: a cadaveric study. Reg Anesth Pain Med, 2019, 6: rapm-2018-100355.
19. Sankineani SR, Reddy ARC, Eachempati KK, et al. Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol, 2018, 28(7): 1391-1395.
20. Patterson ME, Vitter J, Bland K, et al. The effect of the IPACK block on pain after primary tka: a double-blinded, prospective, randomized trial. J Arthroplasty, 2020, 35(6S): S173-S177.
21. Kandarian B, Indelli PF, Sinha S, et al. Implementation of the IPACK (infiltration between the popliteal artery and capsule of the knee) block into a multimodal analgesic pathway for total knee replacement. Korean J Anesthesiol, 2019, 72(3): 238-244.
22. Ohgoshi Y, Matsutani M, Kubo EN. Use of IPACK block with continuous femoral triangle block for total knee arthroplasty: a clinical experience. J Clin Anesth, 2019, 54: 52-54.
23. Eccles CJ, Swiergosz AM, Smith AF, et al. Decreased opioid consumption and length of stay using an IPACK and adductor canal nerve block following total knee arthroplasty. J Knee Surg, 2021, 34(7): 705-711.
24. Kim DH, Beathe JC, Lin Y, et al. Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg, 2019, 129(2): 526-535.
25. Kampitak W, Tanavalee A, Ngarmukos S, et al. Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia. J Arthroplasty, 2019, 34(2): 295-302.
26. Kampitak W, Tanavalee A, Ngarmukos S, et al. Motor-sparing effect of iPACK (interspace between the popliteal artery and capsule of the posterior knee) block versus tibial nerve block after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med, 2020, 45(4): 267-276.

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