Femoral Nerve Block Combined with Sciatic Nerve Block, Adductor Canal Block or (Interspace between the Popliteal Artery and The Capsule of the Posterior Knee) Ipack Block for Postoperative Analgesia after Major Knee Surgeries: A Randomized trial

doi:10.21608/ejhm.2025.451033

Femoral Nerve Block Combined with Sciatic Nerve Block, Adductor Canal Block or (Interspace between the Popliteal Artery and The Capsule of the Posterior Knee) Ipack Block for Postoperative Analgesia after Major Knee Surgeries: A Randomized trial

Document Type : Original Article

10.21608/ejhm.2025.451033

Abstract

Background: Since unmanaged pain might result in further difficulties, postoperative analgesia is essential to a complete recovery. Improved pain control and faster mobilization following knee surgeries are achieved by combining femoral nerve block with sciatic nerve block and adductor canal block (ACB), or infiltration between the popliteal artery and the capsule of the knee (IPACK) for postoperative analgesia following major knee surgeries.

Objective: This study aimed to compare local anesthetic IPACK with ACB or sciatic nerve block (anterior approach) in conjunction with femoral nerve block. Methods: Cases between the ages of 40 and 75 undergoing major knee surgery were the subjects of this double-blind, randomized trial that was conducted at Menoufia University Hospitals. All volunteers received femoral nerve block and general anesthesia before being randomly assigned to one of three cohorts: IPACK, ACB and sciatic nerve block (SNB). Over the course of 48 hours, the research assessed pain, morphine use, surgical time, and complications following surgery. Results: The IPACK cohort experienced the least amount of discomfort, the longest period of time before receiving more analgesia, and the least amount of opiate use. The IPACK cohort also consumed the least amount of morphine and paracetamol overall. All cohorts showed similar complications and case satisfaction, with IPACK and ACB having a minor edge over sciatic nerve block.

Conclusion: Compared to ACB and SNB, the IPACK block plus a femoral nerve block produced better pain alleviation, decreased opioid consumption, and postponed further analgesia, while maintaining comparable hemodynamic stability and complication rates.

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