2023 ISAKOS Biennial Congress ePoster
Decreased Opioid Consumption and Post-Operative Pain Using an IPACK and Adductor Canal Nerve Block following ACL Reconstruction with Bone-Patellar Tendon-Bone Autograft: A Single-Blind, Randomized Controlled Study
Naina Rao, BS UNITED STATES
Jairo Triana, BS, New York, NY UNITED STATES
Kirk Anthony Campbell, MD, New York, NY UNITED STATES
Laith M. Jazrawi, MD, New York, NY UNITED STATES
Michael J Alaia, MD, New York, New York UNITED STATES
Jovan Popovic, MD, New York, NY UNITED STATES
David Furgiuele, MD, New York, NY UNITED STATES
Eric Jason Strauss, MD
NYU Langone Health, New York, NY, UNITED STATES
FDA Status Not Applicable
Summary
Patients enrolled in a single blinded- randomized control trial who received combined ACB and IPACK nerve blocks while undergoing ACL reconstruction had lower pain scores and opioid usage in the first 3 post-operative days than those who received an ACB alone
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Abstract
Objective
In an effort to reduce reliance on opioid analgesics, an increased emphasis has been placed on peripheral nerve blocks for pain control following anterior cruciate ligament (ACL) reconstruction. Sole administration of the adductor canal block (ACB) may be inadequate, as it spares sensory function to the posterior aspect of the knee. This region can be specifically targeted using an IPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) block, potentially leading to improved pain control. The purpose of this study was to compare clinical outcomes of patients undergoing ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft with an ACB alone versus combined ACB and IPACK block.
Methods
We prospectively recruited patients undergoing ACL reconstruction with BPTB autograft at a single institution. Patients in the control group received the standard-of-care ACB consisting of 15-ml of Bupivacaine (0.25%). Patients in the experimental group received an additional IPACK block with 20-ml of Bupivacaine (0.25%). Post-operative VAS scores, and pain control satisfaction were collected at 24hrs, 48hrs, 72hrs and one week postoperatively. The type and quantity of analgesics including 325-5 mg Percocet collected in morphine milligram equivalents (MME), Tylenol, and other pain medications were recorded at each time point. Variables were assessed using Shapiro-Wilks test for normality and T-test or non-parametric tests for continuous variables and Chi-squared tests for categorical variables.
Results
Eighty-seven patients were preliminarily analyzed, 43 patients were prospectively randomized to the control arm and 45 to the experimental arm. There were no statistically significant differences between the groups with respect to age, BMI, or sex. Patients who received the IPACK block had significantly lower day 1 and day 3 pain scores (54.05 vs. 67.98, p = 0.011) (42.21 vs. 55.24, p = 0.013) and higher satisfaction with pain control on day 1 (7.18 vs. 5.76, p=0.006) than those in the control arm. Patients in the control arm used almost 65% more opioids during Day 1, 44% more dure day 2 and 104% more during Day 3 than those with the IPACK block (Day 1: 30.00 vs. 18.24 MME, p=0.004; Day 2: 33.57 vs. 23.35, p = 0.04; Day 3: 25.34 vs. 12.38, p = 0.009).
Conclusion
Patients who received combined IPACK and ACB blocks exhibited lower narcotic use, better pain control and higher satisfaction compared to those who received the standard-of-care ACB alone following ACL reconstruction using autograft tissue.