Comparative study on the application of ACB+iPACK combined nerve block versus local infiltration during total knee arthroplasty procedure

SUN Zaijiao; XIONG Xiang; PU Jianxue; TANG Lingling; LIU Ping; SUN Meirong

doi:10.3969/j.issn.1674-666X.2024.05.004

Abstract：Objective To compare the application effects of ultrasound-guided adductor canal block(ACB)combined with interspace between the popliteal artery and the posterior knee capsule(iPACK)block versus local infiltration analgesia(LIA)during total knee arthroplasty(TKA)procedure.Methods From June 2023 to June 2024,80 patients with unilateral knee osteoarthritis undergoing TKA at the Third People's Hospital of Yunnan Province were randomly divided into two groups.Forty patients received LIA through layer-by-layer injection into the posterior joint capsule,synovium,and subcutaneous tissue(LIA group),while 40 patients underwent ultrasound-guided ACB+iPACK combined nerve block(nerve block group).The general surgical indicators,morphine consumption rate at various postoperative time points,visual analog scale(VAS)scores for movement and rest,15-item quality of recovery(QoR-15)scale scores,muscle strength changes,and occurrences of adverse events and complications were compared between the two groups.Results There were no statistically significant differences between the two groups in general surgical indicators such as operation time,anesthesia time,and length of stay;morphine consumption rate and movement VAS scores at various postoperative time points;resting VAS scores,QoR-15 scale scores at 24,48,and 72 hours postoperatively;and incidence rates of postoperative sleep disruption,nausea,vomiting,and dizziness(P>0.05).The nerve block group had higher resting VAS scores upon admission to the postanesthesia care unit(PACU)and at 2,6,and 12 hours postoperatively,higher total hospitalization costs,and weaker muscle strength at 24,48,and 72 hours postoperatively compared to the LIA group,with statistically significant differences(P<0.05).Conclusions Both ACB+iPACK combined nerve block and LIA can effectively alleviate postoperative pain after TKA with high safety.The LIA group exhibited better early analgesia efficacy and lower total hospitalization costs.Additionally,ACB+iPACK combined nerve block had a certain impact on postoperative muscle strength,which was not conducive to early patient recovery.It is recommended that experienced surgeons prefer LIA after TKA and consider adding nerve block or other adjuvant analgesic medications in cases of inadequate analgesia.