Pain Management and Research
Efficacy of adductor canal combined with IPACK block for multimodal analgesia after total knee arthroplasty
Min Li, Lu Chen, Huanghui Wu, Fei Yang, Guozhong Chen, Xiaozhi Wu
Published 2019-05-20
Cite as Chin J Anesthesiol, 2019, 39(5): 574-577. DOI: 10.3760/cma.j.issn.0254-1416.2019.05.017
Abstract
ObjectiveTo evaluate the efficacy of adductor canal combined with interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block for multimodal analgesia after total knee arthroplasty (TKA).
MethodsSixty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 55-78 yr, scheduled for elective unilateral TKA under combined spinal-epidural anesthesia, were assigned into 2 groups (n=30 each) using a computer random number method: adductor canal combined with IPACK block group (group A+ I) and adductor canal block group (group A). Preventive multimodal analgesia was applied as follows: preoperative pain management education was performed; flurbiprofen 50 mg was intravenously injected before induction of anesthesia, and celecoxib 200 mg was taken orally after surgery, twice a day, to control inflammatory pain; ultrasound-guided adductor canal combined with IPACK block was performed in group A+ I, and ultrasound-guided adductor canal block was performed in group A to inhibit incisional pain; nalbuphine 0.08 mg/kg was intravenously injected to inhibit breakthrough pain. Postoperative numeric rating scale (NRS) scores at rest (NRSr) and on movement (NRSm) were maintained <5 within 48 h after surgery. The area under the curve(AUC) of NRSr and NRSm (AUCNRSr and AUCNRSm)were calculated within 48 h after surgery. The requirement for nalbuphine as rescue analgesic was recorded. The maximum number of ambulatory steps and maximum range of knee motion were recorded on 1 and 2 days after surgery. The development of nerve block- and postoperative rehabilitation training-related adverse events and postoperative length of hospitalization were also recorded.
ResultsCompared with group A, AUCNRSr and AUCNRSm were significantly decreased, the consumption of nalbuphine was reduced, and the maximum number of ambulatory steps and maximum range of knee motion were increased (P<0.05), and no significant change was found in the requirement for nalbuphine or length of hospitalization in group A+ I (P>0.05). No nerve block- and postoperative rehabilitation training-related adverse events were found in neither group.
ConclusionAdductor canal combined with IPACK block can provide a relatively perfect efficacy when used for multimodal analgesia after TKA and is helpful for patient′s recovery.
Key words:
Nerve block; Arthroplasty, replacement, knee; Analgesia
Contributor Information
Min Li
Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou 350025, China
Lu Chen
Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
Huanghui Wu
Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou 350025, China
Fei Yang
Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou 350025, China
Guozhong Chen
Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou 350025, China
Xiaozhi Wu
Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou 350025, China