الفهرس 
Total knee ArthroplastyOnly 14 pages are availabe for public view
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Abstract
SUMMARY
T
otal knee arthroplasty (TKA) is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. However, despite the effectiveness of this approach, the rehabilitation of limbs after a TKA operation still faces critical challenges. Pain is the most difficult factor to control following TKA; however, the development of an ultrasound- guided nerve block and multi- modal analgesia and motor-sparing regional anesthetic blocks has helped to reduce postoperative pain to a certain extent to help achieve early limb autonomous movement and facilitates early knee range of motion (ROM), speed up the rehabilitation process, reduces overall narcotic consumption, shorten hospital stays, and improve patient satisfaction.
The saphenous nerve block via the adductor canal approach can be successfully used to block the medial sides of the foot and the ankle after foot and ankle surgeries, either as a solo block or in addition to the popliteal nerve block. The adductor canal block (ACB) can spare quadriceps muscle strength; however, due to its predominantly anteromedial coverage of the peri-patellar and intra-articular aspects of the knee, ACB fails to alleviate posterior knee pain which may be severe in intensity.
Ultrasound-guided Infiltration between the Popliteal Artery and the Capsule of the Knee (IPACK) is a novel regional anesthetic modality that has been proposed in recent years as a potential alternative to the sciatic nerve block with good analgesic effect and little impact on the muscle strength. The iPACK block targets the medial and lateral genicular nerves, and other articular branches innervating the posterior aspect of the knee joint which in theory has less motor and sensory blockade below the knee than the more proximal sciatic nerve block.
The aim of the study is to compare postoperative pain management and post-operative analgesia between iPACK block and Adductor canal block in total knee arthroplasty cases.
The study was conducted on 30 random patients who were scheduled to undergo total knee arthroplasty and where divided into 2 equal groups:
group I:
Patients in group I (n = 15) will receive spinal anaesthesia followed by iPACK block at the end of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions.
group A:
Patients in group A (n = 15) will receive spinal anaesthesia followed by Adductor canal block at the end of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions.
The two groups were adequately monitored and assessed post-operatively for 24 hours and they were compared regarding analgesic outcome by recording time for first for analgesic need, total consumption of opioid and pain score during walking and climbing stairs. Side effects were also monitored and compared.
As for the comparison between effect of IPACK block and Adductor canal block as regard post-operative pain in total knee arthroplasty, it showed that there is significance regarding the numeric version of the visual analogue scale (VAS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block and 2-4 for IPACK block. These findings with our study primary and secondary outcomes showed that Adductor canal block has more analgesic effect with respect to IPACK block regarding pain assessment but with no significant difference regarding the by the time till first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative.