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IPACK Block Efficacy for Acute Pain Management after Total Knee Replacement: A Review

  • Acute Pain Medicine (R Urman, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as it is designed to inhibit nerve branches innervating this area. In this article, we examine the rationale behind the IPACK procedure, how it is performed, and clinical trials examining its efficacy.

Recent Findings

5 of the 7 clinical trials examined in this article showed the IPACK + ACB block to show superior efficacy in treating pain following TKR compared to other blocks. These blocks included PMDI+ACB, SPANK+ACB, PAI+ACB, ACB alone, and SCAB. 2 of the 7 clinical trials showed the IPACK + ACB to be less effective in managing patients pain following TKR compared to other blocks which included the CACB and 4 in 1 block.

Summary

In most instances, the IPACK + ACB showed superior efficacy in managing patients’ pain following TKR when compared to other types of nerve blocks. This was determined by measuring usage of opioids, reported postoperative pain, and length of hospital stays following TKR. Thus, we suppose the IPACK block may be used in conjunction with the ACB to effectively reduce patient’s pain following TKR.

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Data Availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA

    William C. Upshaw, John M. Richey & Mark V. Frolov

  2. School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, 70119, USA

    Joseph P. Tassin

  3. Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Benjamin C. Miller, Jeffrey Sterritt, Charles J. Fox, Shahab Ahmadzadeh & Sahar Shekoohi

  4. WakeMed Anesthesia, 3000 New Bern Ave, Raleigh, NC, 27610, USA

    Aaron J. Kaye

  5. Department of Anesthesiology, Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA

    Alan D. Kaye

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  1. William C. Upshaw
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All authors listed have made a direct and intellectual contribution to the work and approved for publication.

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Correspondence to Sahar Shekoohi.

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Upshaw, W.C., Richey, J.M., Tassin, J.P. et al. IPACK Block Efficacy for Acute Pain Management after Total Knee Replacement: A Review. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01237-3

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