Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.012
Brazilian Journal of Anesthesiology
Original Investigation

The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty

O impacto do IPACK combinado com o bloqueio do canal adutor sob orientação de ultrassom na função motora precoce após artroplastia total do joelho

Fang-Yu Zheng; Yong-Bo Liu; Hui Huang; Shuai Xu; Xiao-Jun Ma; Ying-Zhi Liu; Hai-Chen Chu

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Abstract

Background: This study aimed to evaluate the impact of Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) combined with an adductor canal block under the guidance of ultrasound on early motor function after Total Knee Arthroplasty (TKA).

Methods: A sample of 60 cases who were scheduled for elective unilateral TKA were divided into two groups using random number table method: a group with IPACK combined with an adductor canal block (I group, n = 30), and a group with femoral nerve block combined with superior popliteal sciatic nerve block (FS group, n = 30). Before anesthesia induction was completed, the patients in I group received an ultrasound-guided adductor canal block with 15 mL of 0.375% ropivacaine and an IPACK block with 25 mL of ropivacaine, and the patients in FS group received a femoral nerve block and a superior popliteal sciatic nerve block with 20 mL of 0.375% ropivacaine under ultrasound guidance. Post-operation, all the patients received patient-controlled intravenous analgesia combined with an oral celecoxib capsule to relieve pain and maintain a visual analogue scale score of = 3.

Results: The quadriceps femoris muscle strength score was significantly higher in I group than in FS group (p = 0.001), while the modified Bromage score were significantly lower and walking distance results were significantly higher in I group than in FS group (both p = 0.000).

Conclusion: Compared with femoral nerve block combined with superior popliteal sciatic nerve block, IPACK combined with adductor canal block had a mild impact on early motor functions after TKA.

Keywords

IPACK, Peripheral nerve blocks, Regional anesthesia, Adductor canal block, Total knee arthroplasty

Resumo

Introdução: Este estudo teve como objetivo avaliar o impacto da infiltração entre a artéria poplítea e a cápsula do joelho posterior (IPACK) combinada com o bloqueio do canal adutor sob orientação de ultrassom na função motora precoce após artroplastia total do joelho (ATJ).

Métodos: Uma amostra de 60 casos programados para ATJ eletiva unilateral foram divididos em dois grupos usando o método de tabela de números aleatórios: um grupo com IPACK combinado com um bloqueio do canal adutor (grupo I, n = 30), e um grupo com nervo femoral bloqueio combinado com bloqueio do nervo ciático poplíteo superior (grupo FS, n = 30). Antes do término da indução da anestesia, os pacientes do grupo I receberam bloqueio do canal adutor guiado por ultrassom com 15 mL de ropivacaína a 0,375% e bloqueio IPACK com 25 mL de ropivacaína, e os pacientes do grupo FS receberam bloqueio do nervo femoral e superior bloqueio do nervo ciático poplíteo com 20 mL de ropivacaína a 0,375% sob orientação ultrassonográfica. No pós-operatório, todos os pacientes receberam analgesia intravenosa controlada pelo paciente combinada com uma cápsula oral de celecoxibe para aliviar a dor e manter uma pontuação na escala visual analógica ≤ 3.

Resultados: O escore de força do músculo quadríceps femoral foi significativamente maior no grupo I do que no grupo FS (p = 0,001), enquanto o escore de Bromage modificado foi significativamente menor e os resultados de distância caminhada foram significativamente maiores no grupo I do que no grupo FS (ambos p = 0,000).

Conclusão: Comparado com o bloqueio do nervo femoral combinado com o bloqueio do nervo ciático poplíteo superior, o IPACK combinado com o bloqueio do canal adutor teve um impacto leve nas funções motoras iniciais após ATJ.
 

Palavras-chave

Bloqueios de nervos periféricos, Anestesia regional, Bloqueio do canal adutor, Artroplastia total de joelho

References

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Submitted date:
10/09/2019

Accepted date:
04/14/2021

60982989a9539561ca0666b6 rba Articles

Braz J Anesthesiol

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