Cadaveric data demonstrated that IPACK mainly anesthetizes the articular branches from the tibial and obturator nerves. The interspace between the popliteal artery and capsule of the knee (IPACK) is a novel regional anesthetic approach that could supply analgesic effects on the posterior capsule without compromising muscle strength. Insufficient pain control may hinder early ambulation, hamper the quality of recovery, and increase the utilization of opioids. Due to osteophytes removal and soft tissue release on the backside of the knee, posterior knee pain is also a significant issue. However, patients usually experience moderate-to-severe postoperative knee pain. Total knee arthroplasty (TKA) is an effective intervention for end-stage knee diseases and could relieve pain, restore function, and improve patients’ quality of life. Moderate-level evidence confirmed that IPACK was related to better results in pain scores, morphine usage, and functional recovery without increasing the risk of complications. There was no significant difference in the other outcomes. And IPACK reduced the rate of sleep disturbance (on POD 1) (RR = 0.39, 95% CI 0.19 to 0.81). Functional recovery outcomes regarding ambulation distances (on the second postoperative day ) (WMD = 1.74, 95% CI 0.34 to 3.15) and quadriceps muscle strength (at 0 degree) (WMD = 0.41, 95% CI 0.04 to 0.77) favored IPACK.
Subgroup analysis found reduced oral morphine consumption from 24 to 48 h (WMD − 2.98, 95% CI − 5.71 to − 0.24) and reduced rate of morphine requirement from 12 to 24 h (relative risk = 0.51, 95% CI 0.31 to 0.83). IPACK reduced the overall morphine consumption (WMD − 2.56, 95% CI − 4.63 to − 0.49). IPACK also significantly reduced rest pain scores (WMD − 0.49, 95% CI − 0.74 to − 0.24), and the benefits were observed from 6 to 12 h and beyond one week. The benefits were observed from 2 to 4 h, 6 to 12 h, and beyond one week. IPACK was associated with lower ambulation pain scores (weight mean difference − 0.49, 95% confidence interval − 0.72 to − 0.26). Thirteen RCTs involving 1347 knees were included. Secondary outcomes included pain score at rest, morphine usage, functional recovery, clinical outcomes, and complications. The primary outcome was the ambulation pain score on a visual analogue scale (VAS) of 0–10. Studies comparing patients receiving IPACK to patients not receiving IPACK were included. PubMed, Medline, Embase, Cochrane Library, and other databases were searched from inception to February 1, 2021. However, controversy remains regarding the efficacy of adding the interspace between the popliteal artery and capsule of the knee (IPACK) into multimodal analgesia protocol. Most patients will experience moderate-to-severe postoperative knee pain, significantly affecting rehabilitation.
Total knee arthroplasty (TKA) is a standard treatment for end-stage degenerative knee disease.
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