2023 ISAKOS Biennial Congress ePoster
Surgeon Directed Arthroscopic IPACK Block and Impact on Rate Of “Rescue” Nerve Block After Primary Anterior Cruciate Ligament Reconstruction Surgery
Philip Hanna, MD, Farmington, CT UNITED STATES
Katherine June Coyner, MD, MBA, Farmington, CT UNITED STATES
Robert A. Arciero, MD, Farmington, CT UNITED STATES
Cory M. Edgar, MD, PhD, Farmington, CT UNITED STATES
Julie P Burland, PhD, Storrs, CT UNITED STATES
University of Connecticut Health Center, Farmington, CT, UNITED STATES
FDA Status Not Applicable
Summary
The arthroscopic assisted IPACK block is a safe and efficient procedure for postoperative pain control after primary ACL reconstruction and can reduce the risk for subsequent rescue nerve block.
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Abstract
Introduction
We describe the safety and efficacy of a surgeon performed intra-operative posterior knee capsule block. The infiltration between popliteal artery and capsule of the knee or IPACK block, traditionally done by anesthesia with ultrasound, is a motor sparring nerve block which can provide posterior knee analgesia following knee surgery and serve as an adjunct to femoral nerve blocks. The purpose of this study was to examine rates, and the relative efficacy and safety of this technique in patients undergoing anterior cruciate ligament (ACL) reconstruction.
Methods
Patients who received primary ACL reconstruction during a three-year period were included in the analysis. Patients were divided into two groups based on whether they received an arthroscopic IPACK block. The primary outcome was the need for postoperative rescue nerve block. The secondary outcome was the incidence of complications related to the IPACK block.
Results
325 patients who underwent primary ACL reconstruction were included. Of these patients, 117 received the IPACK block and 208 did not receive it. There was no statistically significant difference in patient’s age and gender between the groups. There was a trend towards more rescue blocks in patients who did not receive the IPACK block compared to those who received it (10.5% vs 6.8% respectively, p=0.264). This trend reached statistical significance when we performed a subgroup analysis of patients who received concomitant meniscus repair (17.4% vs 4.7% respectively, p=0.017). Logistic regression analysis demonstrated that use of an IPACK block decreased the risk of receiving a rescue block by approximately 50%. No complications related to the IPACK block were reported.
Conclusion
The arthroscopic assisted IPACK block is a safe and efficient procedure for postoperative pain control after primary ACL reconstruction and can reduce the risk for subsequent rescue nerve block.