![]() ![]() Optimal pain control is a key component of rapid recovery and discharge. Total knee replacement (TKR) is one of the most common surgical procedures in the United States. However, it may be an appropriate method to improve immediate analgesic effects after TKR. The addition of an IPACK block to multimodal analgesia regiments does not reduce the postoperative opioid consumption nor improve functional performance. Furthermore, other postoperative outcomes, including cumulative distance ambulated and LOS, were also not improved by the addition of an IPACK. Interestingly, IPACK supplementation did not reduce opioid consumption, especially in the first 24 hours after surgery. The most important finding in our study was that although IPACK block supplementation improved pain scores at 12 hours with rest or activity after surgery, no such benefit was observed at subsequent time points during the postoperative period. Results:įive RCTs with a total of 467 patients were included. Secondary outcomes included cumulative opioid consumption, cumulative distance ambulated, and length of stay (LOS). The primary outcome was the pain scores with rest and activity. Only level I randomized controlled trials (RCTs) were included in our study. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The purpose of this study is to systematically review the level I evidence in the literature to ascertain whether IPACK block can bring additional analgesic benefits to existing multimodal analgesia regimens. Ĭurrently, no meta-analysis exists elucidate the analgesic effect of adding IPACK block to our current multimodal analgesia regimen after total knee replacement (TKR). The work cannot be used commercially without permission from the journal. #Ipack blocks. license#This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. ![]() The authors have no funding and conflicts of interests to disclose.Īll data generated or analyzed during this study are included in this published article and its supplementary information files. Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement: a systematic review of the literature and meta-analysis of 5 randomized controlled trials. #Ipack blocks. how to#How to cite this article: Wang F, Ma W, Huang Z. ∗Correspondence: Zhihui Huang, The First People's Hospital of Changzhou, 185 Juqian Road, Changzhou 213003, Jiangsu, China (e-mail: ).Ībbreviations: ACB = adductor canal block, LIA = local infiltration analgesia, LOS = length of stay, RCTs = randomized controlled trials, SMD = standardized mean differences, TKR = total knee replacement. I hope that helps.Department of Orthopedics, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China. If you do opt to do a combined approach, where the surgeon typically uses large volumes of local anesthesia, your best bet is to use a relatively low volume for your iPACK and AC (as you are doing with 20ml and 12ml, respectively) and use a low concentration local anesthetic (I would consider using 0.2% ropivacaine with dexamethasone as opposed to 0.5% for your AC). There is always going to be some degree of toxicity (and medicolegal) risk combining blocks with local anesthesia infiltration (both standard LA and liposomal LA). This is especially true since your blocks and their infiltration are likely separated in time. ![]() Your total dose does seem reasonable assuming your Exparel dose is 20ml (i.e. This is a very common question: is it OK to do nerve blocks in addition to infiltration with liposomal bupivacaine? The short answer is that we don't know for certain and many anesthesiologists avoid this combination out of fear for toxicity. ![]()
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