Thus, it is believed that the IPACK block could block the terminal branches of the obturator and sciatic nerve. Anatomical study found that the injection of dye into the interspace between the popliteal artery and the posterior capsule of the knee (IPACK) could spread into the entire popliteal fossa and stain popliteal nerve plexus. Therefore, it has become the direction of our research to do an excellent job of posterior knee analgesia. However, ACB could only block the anteromedial sensory nerves of the knee joint, and approximately 72–89% of patients suffered severe postoperative pain originated from the posterior of the knee. Adductor canal block (ACB) was a motor-sparing nerve block that provides an analogous analgesic effect to femoral nerve block. The ideal postoperative analgesia management strategy of TKA requires not only providing adequate postoperative analgesia but also retaining the muscle strength of the limb at most. However, motor never block could prevent rapid recovery, extend patients’ hospital stays. Recent studies found that the pain after TKA could be controlled by femoral and sciatic nerve blocks. Therefore, anesthesiologists and surgeons are consistently seeking ways to effectively manage the postoperative pain. However, patients underwent TKA usually experience excruciating postoperative pain which decreases patient satisfaction, hampers early mobilization, prolong hospital stay, and worsen postoperative function. Total knee arthroplasty (TKA) has been recognized as an effective therapy for patients with end-stage knee osteoarthritis. Knee Osteoarthritis, as one of the most common forms of knee disease, is widely found in the elderly population. This study was registered at Chinese Clinical Trial Registry ( ChiCTR2200059139 registration date: enrollment date: ). However, the opioids consumption was not decreased by adding distal IPACK to CACB. The combination of CACB and distal IPACK block could decrease the incidences of moderate-severe posterior knee pain, improve the postoperative pain over the first 24 hours after TKA, as well as promoting recovery of motor function. There was no difference in term of cumulative opioids consumption between group CACB+IPACK and group CACB+SHAM. The satisfaction for pain management was higher in group CACB+IPACK than that of the group CACB+SHAM. 40.83 ± 6.65 p = 0.009) were superior in group CACB+IPACK than that of the group CACB+SHAM in postoperative day 1. The overall VAS scores were lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours and 8 hours at rest and 4 hours, 8 hours, 24 hours during active flexion after TKA. The VAS scores of the posterior knee were lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours, 8 hours, and 24 hours after TKA. The incidence of moderate-severe pain of the posterior knee was lower in group CACB+IPACK than that of the group CACB+SHAM at 4 hours (17.1% vs. Secondary outcomes included the incidence of postoperative pain originated from the posterior knee, visual analogue scale (VAS) score, range of motion, ambulation distance, and satisfaction for pain management. The primary outcome was cumulative opioid consumption. Patients undergoing unilateral, primary TKA were allocated into group CACB+SHAM (receiving CACB plus sham block) or group CACB+IPACK (receiving CACB plus IPACK block). This study aimed to determine the hypothesis that continuous adductor canal block (CACB) combined with the distal interspace between the popliteal artery and the posterior capsule of the knee (IPACK) block could effectively alleviate the pain of the posterior knee, decrease opioids consumption, and promote early recovery and discharge. The optimal analgesia for total knee arthroplasty (TKA) requires excellent analgesia while preserving muscle strength.
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