Recent publications consider the use of femoral and sciatic nerve blocks to be the gold standard of peripheral nerve blockade for TKA. 7, 8 This is the first prospective study investigating its utility within a multimodal total knee replacement pathway. 5, 6 It affects the medial and lateral superior genicular nerves that provide analgesia to the posterior capsule of the knee joint. IPACK provides analgesia to the posterior compartment of the knee without compromising foot strength. 2 Studies are available on the combination of PAIs and adductor canal blocks (ACBs), 3, 4 but there are currently no prospective double-blinded randomized controlled trials evaluating the incorporation of the infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block. 2 By utilizing a number of analgesic strategies, including “motor-sparing” peripheral nerve blocks and periarticular injections (PAIs), patients’ recoveries may be enhanced by promoting early postoperative ambulation, improving pain scores, and reducing opioid consumption. 1 Multimodal analgesia is incorporated into most clinical pathways to facilitate earlier ambulation, improve patient comfort, and enhance patient satisfaction. Optimal pain control is a critical component of expeditious recovery and discharge. Total knee arthroplasty (TKA) is one of the most common surgical procedures in the United States. Meaning: The addition of infiltration between the popliteal artery and capsule of the posterior knee and adductor canal block are valuable modalities to add to a multimodal pathway.Findings: The addition of motor-sparing blocks augmented periarticular injections by significantly improving postoperative analgesia after total knee arthroplasty. Question: Can motor-sparing blocks enhance multimodal analgesia pathways that include periarticular injections?.This study strongly supports IPACK and ACB use within a multimodal analgesic pathway. The addition of IPACK and ACB to PAI significantly improves analgesia and reduces opioid consumption after total knee arthroplasty compared to PAI alone. 001), and reduced need for intravenous patient-controlled analgesia ( P =. 028, POD 0), less intravenous opioids ( P <. Patients in the intervention group were more satisfied, had less opioid consumption ( P =. In addition, NRS pain scores on ambulation on POD 0 (−3.5 P <. The intervention group reported significantly lower NRS pain scores on ambulation than the control group on POD 1 (difference in means, −3.3 P <. Secondary outcomes included numeric rating scale (NRS) pain scores, patient satisfaction, and opioid consumption. The primary outcome was pain on ambulation on POD 1. Patients either received (1) a PAI (control group, n = 43) or (2) an IPACK with an ACB and modified PAI (intervention group, n = 43). This triple-blinded randomized controlled trial included 86 patients undergoing unilateral total knee arthroplasty. We hypothesized that the addition of ACB and IPACK to PAI would lower pain on ambulation on postoperative day (POD) 1 compared to PAI alone. Motor-sparing peripheral nerve blocks, such as the infiltration between the popliteal artery and capsule of the posterior knee (IPACK) and the adductor canal block (ACB), may augment PAI in multimodal analgesic pathways for knee arthroplasty, but supporting literature remains rare. Periarticular injections (PAIs) are becoming a staple component of multimodal joint pathways.
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