• Tayfun Et, Muhammet Korkusuz, Betül Basaran, Rafet Yarımoğlu, Hatice Toprak, Ayşegül Bilge, Nuh Kumru, and İlker Dedeli.
• Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey. drtayfunet@gmail.com.
• J Anesth. 2022 Apr 1; 36 (2): 276-286.

PurposeThe infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to provide analgesia without loss of muscle strength and is effective in functional recovery. This study compared iPACK + ACB (adductor canal block) with PAI (periarticular infiltration) + ACB and ACB alone in terms of postoperative analgesia and functional improvement.MethodsThis double-blinded randomized controlled trial included 105 patients undergoing unilateral total knee arthroplasty. Patients received ACB, iPACK + ACB, and PAI + ACB along with spinal anesthesia. The primary outcome was the area under the curve (AUC) numeric rating scale (NRS) at 48 h. Secondary outcomes were cumulative postoperative analgesic consumption within 48 h, timed up-and-go test, range of motion, length of hospital stay, patient satisfaction, and adverse events.ResultsThe 48-h AUC movement NRS score in the iPACK + ACB group was significantly lower than in the PAI + ACB and ACB groups (p < 0.05). At the postoperative 48th h, the opioid consumption of the iPACK + ACB group was lower than those of the ACB and PAI + ACB groups (p < 0.001). The patients in the iPACK + ACB group had significantly shorter discharge and mobilization days than the ACB and PAI + ACB groups (p < 0.001).ConclusionsThe adding of an iPACK block to the ACB improves postoperative analgesia and reduces opioid consumption. In addition, this approach improves functional performance and reduces hospital stay.© 2022. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.

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