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The effect of the application of adductor and Infiltration of local anesthetic between the popliteal artery and capsule of the knee (IPACK) block to patients on postoperative recovery and sleep quality following total knee arthroplasty: a randomized, controlled study

Year 2024, Volume: 34 Issue: 5, 609 - 615, 30.10.2024
https://doi.org/10.54005/geneltip.1404497

Abstract

Aim: The adductor canal block (ACB) and IPACK (Infiltration of local anesthetic between the popliteal artery and capsule of the knee) block are motor protective blocks that provide effective analgesia and allow early ambulation. The aim of this study was to investigate the effect on postoperative recovery and sleep quality of patients applied with ACB and IPACK for total knee arthroplasty (TKA).
Material and Method: This prospective, double-blinded, randomized, controlled study included 80 patients who underwent unilateral TKA under spinal anesthesia. The patients were separated as those applied with ACB+IPACK (Group ACB+IPACK, n=40) and a control group (Group C, n=40). The primary outcome was the postoperative first-day quality of recovery scale (QoR-15). Secondary outcomes were postoperative first and second-day Timed-Up-and-Go (TUG) test and range of motion (ROM), the total amount of rescue opioid drugs required, pain scales at different time points in the first 48 hours postoperatively, sleep evaluation on the postoperative and 6 following nights, and evaluation of sleep quality for 1 month using the Pittsburgh Sleep Quality Index (PSQI).
Results: The QoR on postoperative days 1 and 7 were better in the ACB+ IPACK group than in the control group (p= 0.001, p= 0.002, respectively). On postoperative days 1 and 2, the TUG (p= 0.035, p= 0.019, respectively) and ROM (p=0.003, p=0.000) values were higher in the ACB+ IPCAK group. Postoperative opioid consumption was lower in the ACB+IPACK group (p= 0.012). The PSQI values at 1 month postoperatively were similar in both groups (p =0.095).
Conclusion: The study results demonstrated that ACB+IPACK applied with ultrasound for TKA postoperative analgesia provided effective analgesia, higher QoR and physical performance, and reduced postoperative opioid consumption. However, there was no effect on postoperative sleep quality.

Project Number

02-2022/18

References

  • Manning BT, Kearns SM, Bohl DD, Edmiston T, Sporer SM, Levine BR. Prospective Assessment of Sleep Quality Before and After Primary Total Joint Replacement. Orthopedics 2017; 40: 636–40.
  • Wang Y, Liu Y, Li X, Lv Q, Xia Q, Wang X, et al. Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an Enhanced Recovery After Surgery concept. Sleep Breath Schlaf Atm 2021; 25:1231–7.
  • Su X, Wang DX. Improve postoperative sleep: what can we do? Curr Opin Anaesthesiol 2018; 3: 83–8.
  • Tang X, Lai Y, Du S, Ning N. Analgesic efficacy of adding the IPACK block to multimodal analgesia protocol for primary total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg 2022; 17: 429.
  • Krenk L, Jennum P, Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med 2014; 10: 321–6.
  • Domagalska M, Wieczorowska-Tobis K, Reysner T, Kowalski G. Periarticular injection, iPACK block, and peripheral nerve block in pain management after total knee arthroplasty: a structured narrative review. Perioper Med 2023; 12: 59.
  • Guo J, Hou M, Shi G, Bai N, Huo M. iPACK block (local anesthetic infiltration of the interspace between the popliteal artery and the posterior knee capsule) added to the adductor canal blocks versus the adductor canal blocks in the pain management after total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg 2022;17: 387.
  • Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, et al. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg 2019;129: 526–35.
  • Kertkiatkachorn W, Kampitak W, Tanavalee A, Ngarmukos S. Adductor Canal Block Combined With iPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) Block vs Periarticular Injection for Analgesia After Total Knee Arthroplasty: A Randomized Noninferiority Trial. J Arthroplasty 2021;36: 122-129.
  • Rissanen P, Aro S, Sintonen H, Slätis P, Paavolainen P. Quality of life and functional ability in hip and knee replacements: a prospective study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 1996; 5: 56–64.
  • Krenk L, Jennum P, Kehlet H. Sleep disturbances after fast-track hip and knee arthroplasty. Br J Anaesth 2012; 109: 769–75.
  • Cremeans-Smith JK, Millington K, Sledjeski E, Greene K, Delahanty DL. Sleep disruptions mediate the relationship between early postoperative pain and later functioning following total knee replacement surgery. J Behav Med 2006; 29: 215–22.
  • Kara U, Şimşek F, Kamburoğlu H, Özhan MÖ, Alakuş Ü, İnce ME, et al. Linguistic validation of a widely used recovery score: quality of recovery-15 (QoR-15). Turk J Med Sci 2022; 52: 427–35.
  • Myles PS, Myles DB, Galagher W, Chew C, MacDonald N, Dennis A. Minimal Clinically Important Difference for Three Quality of Recovery Scales. Anesthesiology 2016; 125: 39–45.
  • Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth 2016; 117: 62–72.
  • Fenten MGE, Bakker SMK, Scheffer GJ, Wymenga AB, Stienstra R, Heesterbeek PJC. Femoral nerve catheter vs local infiltration for analgesia in fast track total knee arthroplasty: short-term and long-term outcomes. Br J Anaesth 2018; 121: 850–8.
  • Luo ZY, Yu QP, Zeng WN, Xiao Q, Chen X, Wang HY, et al. Adductor canal block combined with local infiltration analgesia with morphine and betamethasone show superior analgesic effect than local infiltration analgesia alone for total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord 2022; 23: 468.
  • Zeng Y, Wang Q, Hu J, Yang J. Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty. Clin J Pain 2022; 38: 575–81.
  • Morze CJ, Johnson NR, Williams G, Moroney M, Lamberton T, McAuliffe M. Knee pain during the first three months after unilateral total knee arthroplasty: a multi-centre prospective cohort study. J Arthroplasty 2013; 28: 1565–70.
  • Fatah RMN, Abdulrahman BB. A sleep disturbance after total knee arthroplasty. J Fam Med Prim Care 2020; 9: 119–24.

Total diz artroplastisi sonrası hastalara adduktor ve IPACK blok uygulamasının ameliyat sonrası iyileşme ve uyku kalitesi üzerine etkisi: randomize, kontrollü bir çalışma

Year 2024, Volume: 34 Issue: 5, 609 - 615, 30.10.2024
https://doi.org/10.54005/geneltip.1404497

Abstract

Amaç: Adduktor kanal bloğu (ACB) ve popliteal arter ile diz kapsülü arasındaki boşluk ( IPACK ) blokları motor koruyucu bloklardır, hızlı ambulasyon ve etkili analjezi sağlar. Bu çalışma total diz artroplastisi (TDA) için ACB ile IPACK uygulanan hastaların postoperatif iyileşme ve uyku kalitesini etkisini araştırmak için tasarlandı.
Gereç ve Yöntemler: Bu prospektif çift kör randomize kontrollü çalışmaya spinal anestezi altında tek taraflı TDA uygulanan 80 hasta dahil edildi. ACB ve IPACK blok uygulanan tüm hastalar (Grup ACB+IPACK n= 40) ve bir kontrol grubuna (Grup C, n=40 ) ayrıldı. Birincil sonuç, postoperatif 1 gün quality of recovery (QoR-15) ölçeğidir. İkincil sonuçlar; postoperatif 1 ve 2 gün Time up Go (TUG) ve range of motion (ROM) , kurtarıcı opioid ilaçların toplam miktarı ve ameliyat sonrası 48 saat içinde farklı zaman noktalarında ağrı skorları, postoperatif gece ve 6 gün uyku değerlendirmesi ve 1 ay uyku kalitesi indeksi degerledirmesi idi ( PSQI).
Results: ACB+ IPACK grubu control grubuna göre postoperatif 1 ve 7 gün iyileşme skorları daha iyiyidi ( sırasıyla; p= 0.001, p= 0.002 ). Postoperratif 1. ve 2. TUG ( sırasıyla p= 0.035, p= 0.019) ve ROM ( sırasıyla; p= 0.003, p= 0.000 ) değerleri ACB+ IPCAK grubunda daha yüksekti. postoperatif opiodi tüketim ACB+IPACK grubunda daha düşüktü ( p= 0.012). Postoperatif 1 ay PSQI degerleri gruplar arası benzerdi ( p =0.095).
Sonuç: TDA postoperatif analjezi için ultrason ile uygulanan ACB+IPACK daha yüksek QoR ve fiziksel performans sağladığı, postoperaitf opioid tüketimini azalttığı ve etkili analjezi sağladığı yönündedir. Ancak postoperaif uyku kalitesi üzerine etkisiz kaldığıdır.

Project Number

02-2022/18

References

  • Manning BT, Kearns SM, Bohl DD, Edmiston T, Sporer SM, Levine BR. Prospective Assessment of Sleep Quality Before and After Primary Total Joint Replacement. Orthopedics 2017; 40: 636–40.
  • Wang Y, Liu Y, Li X, Lv Q, Xia Q, Wang X, et al. Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an Enhanced Recovery After Surgery concept. Sleep Breath Schlaf Atm 2021; 25:1231–7.
  • Su X, Wang DX. Improve postoperative sleep: what can we do? Curr Opin Anaesthesiol 2018; 3: 83–8.
  • Tang X, Lai Y, Du S, Ning N. Analgesic efficacy of adding the IPACK block to multimodal analgesia protocol for primary total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg 2022; 17: 429.
  • Krenk L, Jennum P, Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med 2014; 10: 321–6.
  • Domagalska M, Wieczorowska-Tobis K, Reysner T, Kowalski G. Periarticular injection, iPACK block, and peripheral nerve block in pain management after total knee arthroplasty: a structured narrative review. Perioper Med 2023; 12: 59.
  • Guo J, Hou M, Shi G, Bai N, Huo M. iPACK block (local anesthetic infiltration of the interspace between the popliteal artery and the posterior knee capsule) added to the adductor canal blocks versus the adductor canal blocks in the pain management after total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg 2022;17: 387.
  • Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, et al. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg 2019;129: 526–35.
  • Kertkiatkachorn W, Kampitak W, Tanavalee A, Ngarmukos S. Adductor Canal Block Combined With iPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) Block vs Periarticular Injection for Analgesia After Total Knee Arthroplasty: A Randomized Noninferiority Trial. J Arthroplasty 2021;36: 122-129.
  • Rissanen P, Aro S, Sintonen H, Slätis P, Paavolainen P. Quality of life and functional ability in hip and knee replacements: a prospective study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 1996; 5: 56–64.
  • Krenk L, Jennum P, Kehlet H. Sleep disturbances after fast-track hip and knee arthroplasty. Br J Anaesth 2012; 109: 769–75.
  • Cremeans-Smith JK, Millington K, Sledjeski E, Greene K, Delahanty DL. Sleep disruptions mediate the relationship between early postoperative pain and later functioning following total knee replacement surgery. J Behav Med 2006; 29: 215–22.
  • Kara U, Şimşek F, Kamburoğlu H, Özhan MÖ, Alakuş Ü, İnce ME, et al. Linguistic validation of a widely used recovery score: quality of recovery-15 (QoR-15). Turk J Med Sci 2022; 52: 427–35.
  • Myles PS, Myles DB, Galagher W, Chew C, MacDonald N, Dennis A. Minimal Clinically Important Difference for Three Quality of Recovery Scales. Anesthesiology 2016; 125: 39–45.
  • Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth 2016; 117: 62–72.
  • Fenten MGE, Bakker SMK, Scheffer GJ, Wymenga AB, Stienstra R, Heesterbeek PJC. Femoral nerve catheter vs local infiltration for analgesia in fast track total knee arthroplasty: short-term and long-term outcomes. Br J Anaesth 2018; 121: 850–8.
  • Luo ZY, Yu QP, Zeng WN, Xiao Q, Chen X, Wang HY, et al. Adductor canal block combined with local infiltration analgesia with morphine and betamethasone show superior analgesic effect than local infiltration analgesia alone for total knee arthroplasty: a prospective randomized controlled trial. BMC Musculoskelet Disord 2022; 23: 468.
  • Zeng Y, Wang Q, Hu J, Yang J. Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty. Clin J Pain 2022; 38: 575–81.
  • Morze CJ, Johnson NR, Williams G, Moroney M, Lamberton T, McAuliffe M. Knee pain during the first three months after unilateral total knee arthroplasty: a multi-centre prospective cohort study. J Arthroplasty 2013; 28: 1565–70.
  • Fatah RMN, Abdulrahman BB. A sleep disturbance after total knee arthroplasty. J Fam Med Prim Care 2020; 9: 119–24.
There are 20 citations in total.

Details

Primary Language English
Subjects Anaesthesiology
Journal Section Original Article
Authors

Tayfun Et 0000-0002-0111-3360

Muhammet Korkusuz 0000-0003-2534-5243

Umman Menendi 0000-0002-6710-0212

Project Number 02-2022/18
Early Pub Date October 27, 2024
Publication Date October 30, 2024
Submission Date December 13, 2023
Acceptance Date August 26, 2024
Published in Issue Year 2024 Volume: 34 Issue: 5

Cite

Vancouver Et T, Korkusuz M, Menendi U. The effect of the application of adductor and Infiltration of local anesthetic between the popliteal artery and capsule of the knee (IPACK) block to patients on postoperative recovery and sleep quality following total knee arthroplasty: a randomized, controlled study. Genel Tıp Derg. 2024;34(5):609-15.