Effects of adductor canal block combined with infiltration between the popliteal artery and capsule of the knee on pain management and early rehabilitation compared with epidural analgesia for patients undergoing total knee arthroplasty: a prospective randomised controlled trial

Total knee arthroplasty (TKA) is often regarded as one of the most painful orthopedic operations. Variety of regional anesthetic procedures are used to reduce this pain. Infiltration between the popliteal artery and capsule of the posterior knee (IPACK) is increasingly being utilized in conjunction with adductor canal block (ACB) to provide adequate analgesia for TKA. The aim of study is to assess the analgesic effectiveness of ACB + IPACK block and epidural analgesia (EA) after TKA during the early stages of physical therapy. This prospective study included 58 patients who underwent unilateral TKA surgery. Patients were randomized into two groups as EA group (n = 30) and ACB + IPACK group (n = 28). The visual analogue scale (VAS) scores of the patients at the postoperative 8th (PO8th) hour, 1st postoperative day (POD1), and postoperative 2nd day (POD2) during the active and passive physical therapy movements, VAS scores during the ambulation, and active and passive range of movement values in POD1 were recorded. In addition, ambulation rates of the patients at the PO8th hour, 25 meters ambulation times in POD1, and completion times of 10 assisted squats in POD1 were recorded. The ACB + IPACK group had a substantially higher PO8th hour VAS score (p = 0.038). However, there was no significant difference in POD1, POD2 VAS scores. The analgesics consumption and VAS scores during ambulation were comparable among groups. Ambulation rate (22 (78.5%) vs. 16 (53.3%), p = 0.043) and speed (139.65 ± 57.12 sec. vs. 188.66 ± 77.95 sec., p = 0.023) were significantly better in the ACB + IPACK group. The strength of quadriceps contractions was similar in both groups. The use of a combination of ACB + IPACK block for postoperative analgesia in TKA patients is not only successful in reducing postoperative pain, but also a promising treatment with favourable effects on early ambulation and rehabilitation.

Postoperative pain management; Peripheral nerve block; Epidural analgesia; Knee arthroplasty; Rehabilitation; Ultrasound-guidance

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