Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period

  • S. R. Sankineani
  • A. R. C. ReddyEmail author
  • Krishna Kiran Eachempati
  • Ajit Jangale
  • A. V. Gurava Reddy
Original Article • KNEE - ARTHROPLASTY



Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves.

Materials and methods

A prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty. The initial 60 consecutive patients received ACB + IPACK (Group 1, n = 60), and the subsequent 60 patients received ACB alone (Group 2, n = 60). All patients were evaluated with VAS score for pain recorded at 8 h, postoperative day (POD) 1 and POD 2 after the surgery. The secondary outcome measures assessed were the range of movement (ROM) and ambulation distance.


VAS score showed significantly (p < 0.005) better values in ACB + IPACK group compared to the ACB group. The mean ROM of knee and ambulation distance also showed significantly better values in ACB + IPACK group compared to the ACB group.


ACB + IPACK is a promising technique that offers improved pain management in the immediate postoperative period without affecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.


IPACK Adductor canal block Knee arthroplasty Postoperative analgesia 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • S. R. Sankineani
    • 1
  • A. R. C. Reddy
    • 2
    Email author
  • Krishna Kiran Eachempati
    • 3
  • Ajit Jangale
    • 1
  • A. V. Gurava Reddy
    • 1
  1. 1.Department of OrthopaedicsSunshine HospitalSecunderabadIndia
  2. 2.Department of AnaesthesiaMediciti Institute of Medical SciencesMedchal, HyderabadIndia
  3. 3.Department of OrthopaedicsMaxcure HospitalMadhapur, HyderabadIndia

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