Analgesic Effect of Dexmedetomidine in IPACK Block during Total Knee Arthroplasty

Li Zheng; Zhang Weisong; Guo Junfei; Li Hui; Lv Haigang

doi:10.3969/j.issn.1008-5572.2025.09.005

Abstract：Objective To evaluate the influence of dexmedetomidine added to infiltration between the popliteal artery and the capsule of the posterior knee(IPACK)block on postoperative analgesia in day surgery unilateral total knee arthroplasty(TKA).Methods Eighty patients scheduled for day surgery unilateral TKA at Honghui Hospital,Xi'an Jiaotong University from March 2024 to March 2025 were randomly allocated into two groups.All patients received standardized general anesthesia combined with ultrasound-guided adductor canal block(0.25％ropivacaine 25 mL)and IPACK block preoperatively.In the trial group the IPACK block was performed with 0.25％ropivacaine plus dexmedetomidine 0.5 μg/kg in a total volume of 12 mL,whereas the control group received 0.25％ropivacaine 12 mL.The trial group comprised 40 patients(13 males,27 females)aged 56～79 years,mean(65.18±5.92)years;the control group comprised 40 patients(9 males,31 females)aged 55～77 years,mean(66.65±5.42)years.Visual analogue scale(VAS)at 6 h,12 h and 24 h after surgery,systemic analgesic consumption within 24 h,number of nocturnal pain-induced awakenings,incidence of adverse reactions and patient satisfaction were compared between the two groups.Results VAS scores for movement at 12 h and for rest at 24 h in the trial group were lower than those in the control group(P＜0.05);VAS scores at other time-points showed no statistically significant inter-group differences(P＞0.05).The trial group had fewer nocturnal pain-induced awakenings than the control group(P＜0.05).There were no statistically significant differences between the groups in 24-h systemic analgesic consumption,incidence of adverse reactions or overall patient satisfaction(P＞0.05).Conclusion Dexmedetomidine combined with IPACK block significantly improves early postoperative analgesia and nocturnal sleep quality in TKA patients without increasing adverse reactions,representing an optimized choice for multimodal analgesia in day surgery of TKA.