Comparison of interspace between the popliteal artery and the capsule of the posterior knee (IPACK) and genicular block for total knee replacement surgery
selcan akesen, burak akesen, teoman atıcı, alp gurbet, cenk ermutlu, ali özyalçın
Objective:To compare the efficacy of genicular block(GB) and the infiltration between popliteal artery and capsule of the knee (IPACK) block on postoperative pain scores, the need for rescue analgesics, range of motion (ROM), walking distance, and perioperative monitorization variables in patients who underwent total knee replacement (TKR) surgery.Methods:Study included 60 ASA I-III adult patients equally divided into three subgroups as the IPACK block group, GB, and the control group. All patients underwent TKR surgery under spinal anesthesia.Each patient was randomized into one of the study groups, and compared in terms of the primary and secondary outcomes.The visual analog scale (VAS) score, mobility, pre- and intraoperative monitorization of systolic and diastolic holding area noninvasive blood pressure, heart rate, and SPO2 were compared between the groups.Results:Patients in the IPACK and GB groups had a significantly lower VAS scores on the postoperative 4h (p<0.01), 8h (p<0.01), 12h (p<0.01), 24h (p<0.05). VAS score was significantly lower in the GB group on the postoperative 4h (5.5±0.55) and 8h (5.0±0.53) in the mobile state compared to the IPACK (8.0±0.47; 8.0±0.43, respectively) and the control group (9.5±0.20; 10±0.28, respectively) (p< 0.01).The use of patient-controlled-analgesia (PCA) devices and button push count for analgesics demand were significantly lower in the GB group on the immediate postoperative period (p<0.01 on the po 0-4 h). Total consumption of morphine equivalents in postoperative day 0 was significantly lower in the GB group (p<0.01, and p<0.001 vs IPACK and control groups, respectively).Degree of flexion was significantly higher in the GB group on the postoperative 12h compared to the IPACK and the control group (p<0.001).Length of hospital stay was significantly lower in the GB group compared to the IPACK and the control group (p<0.05 for both variables). Conclusion:Genicular block is a promising technique that offers improved pain management in the immediate and early postoperative period without adverse effects on systemic and motor variables.
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