Comparing Continuous Adductor Canal Block Alone, with Combined Continuous Adductor Canal Block with iPACK in Terms of Early Recovery and Ambulation in Patients Undergoing Unilateral Total Knee Replacement- A Prospective Randomized Double Blinded Study

Author(s): Manasa Vijay

BACKGROUND Adductor canal block which blocks saphenous nerve which is purely sensory preserves motor functions and hence patients can be mobilized early decreasing complications and enabling early discharge. However, it does not relieve posterior knee pain. iPACK has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves. Our aim was to make patients mobile on the same day of surgery and decrease the hospital stay, aiming for early discharge that is on second post-operative day. METHODS 100 patients of ASA grade 1 and 2 posted for unilateral knee replacement were randomly selected. Group A received ACB + iPACK and group B patients received ACB alone. Post-operative ambulation score, muscle control score, knee flexion in degrees was checked on day 0, 1 and 2. VAS sore was checked at 6, 12 and 24 hrs. RESULTS Patients with combined iPACK with adductor canal block were completely painless after surgery. Whereas patients who received only adductor canal block (continuous) had mild pain on day 0. On day 1 patients in both the groups were absolutely pain free and required no additional dose of analgesics. But patients from both groups of patients were able to walk on the day of surgery comfortably and discharged on day 2. CONCLUSIONS iPACK with adductor canal block is the best mode in multimodal analgesia in treating post-operative pain after total knee replacement leading to decreased post-operative complications (due to quadriceps weakness), decreased nosocomial complications, early patient discharge and better patient satisfaction.