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Analgesic efficacy of adding the IPACK block to a multimodal analgesia protocol for primary total knee arthroplasty
  1. Jason Ochroch1,
  2. Victor Qi1,
  3. Ignacio Badiola1,
  4. Taras Grosh1,
  5. Lu Cai1,
  6. Veena Graff1,
  7. Charles Nelson2,
  8. Craig Israelite2 and
  9. Nabil M Elkassabany1
  1. 1 Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Nabil M Elkassabany, Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA; nabil.elkassabany{at}


Background and objectives Peripheral nerve blocks have been integrated into most multimodal analgesia protocols for total knee arthroplasty (TKA). The adductor canal block (ACB) has gained popularity because of its quadriceps muscle sparing. Similarly, local anesthetic injection between the popliteal artery and the posterior capsule of the knee, IPACK block, has been described to provide analgesia to the posterior capsule of the knee with motor-sparing qualities. This prospective randomized controlled trial aimed to assess the analgesic efficacy of adding the IPACK block to our current multimodal analgesic regimen, including the ACB, in patients undergoing primary TKA.

Methods 119 patients were randomized to receive either an IPACK or a sham block in addition to multimodal analgesia and an ACB. We were set to assess pain in the back of the knee 6 hours after surgery. Other end points included quality of recovery after surgery, pain scores, opioid requirements, and functional measures.

Results Patients who received the IPACK block had less pain in the back of the knee 6 hours after surgery when compared with the sham block: 21.7% vs 45.8%, p<0.01. There was marginal improvement in other pain measures in the first 24 hours after surgery. However, opioid requirements, quality of recovery and functional measures were similar between the two groups.

Conclusion The IPACK block reduced the incidence of posterior knee pain 6 hours postoperatively.

  • analgesia
  • analgesics
  • opioid
  • anesthesia
  • local
  • nerve block
  • outcome assessment
  • health care

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  • Correction notice This article has been corrected since it published Online First. Dr Lu Cai's name has been corrected.

  • Contributors All authors have seen, edited, and approved the manuscript before submission. All authors contributed to the study design and conduct, data analysis, and writing and editing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Dr Elkassabany is a consultant for Foundry therapeutics. Dr Nelson declares working as a consultant for Acutive Medical, Allentwon, Pennsylvania and for Zimmer Biomet.

  • Patient consent for publication Not required.

  • Ethics approval After obtaining iInstitutional rReview bBoard approval at the University of Pennsylvania ( ID: NCT03703206: first posted 10/11/2018).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Raw data can be made available upon reasonable request.