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

• Published in: Current pain and headache reports 2024-07, Vol.28 (7), p.673-679
• Main Authors: Upshaw, William C., Richey, John M., Tassin, Joseph P., Frolov, Mark V., Miller, Benjamin C., Kaye, Aaron J., Sterritt, Jeffrey, Fox, Charles J., Ahmadzadeh, Shahab, Shekoohi, Sahar, Kaye, Alan D.
• Format: Article
• Language: English
• Subjects: Acute Pain - drug therapy; Acute Pain - etiology; Acute Pain Medicine (R Urman; Arthroplasty, Replacement, Knee - adverse effects; Clinical trials; Humans; Internal Medicine; Knee; Medicine; Medicine & Public Health; Nerve Block - methods; Pain; Pain Management - methods; Pain Medicine; Pain, Postoperative - drug therapy; Section Editor; Topical Collection on Acute Pain Medicine; Treatment Outcome
• ISSN: 1531-3433; 1534-3081; 1534-3081
• DOI: 10.1007/s11916-024-01237-3

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.