Objective To compare the analgesic effect of infiltration between the popliteal artery and capsule of the knee (IPACK) block with adductor canal block (ACB) and sciatic nerve block (SNB) with ACB on triceps muscle strength.
Methods Fifty-two patients, 13 males and 37 females, aged 50-80 years, BMI 18-39 kg/m2, ASA physical status Ⅰ or Ⅱ, who scheduled for unilateral TKA were randomly divided into two groups: IPACK block combined with ACB group (group IA) and SNB combined with ACB group (group SA). Before anesthesia induction, 0.25% ropivacaine was used for nerve block under ultrasound guidance. Group IA received IPACK block (20 ml) and ACB (10 ml); SNB (20 ml) and ACB (10 ml) were performed in group SA. After confirming the block effect, the unified laryngeal mask general anesthesia was implemented. All patients received a patient-controlled intravenous analgesia (PCIA) after surgery. The VAS pain scores at rest and activity were recorded 1 day before surgery, immediately after leaving PACU, 4, 8, 24, 48 hours after surgery, and 90 days after surgery. The dosage of sufentanil, the number of PCIA compressions and the recovery analgesia rate within 48 hours after operation were recorded. The muscle strength of triceps and quadriceps were recorded.
Results Compared with group SA, the analgesic effect of group IA was not worse than that of group SA for the upper limit of 95% CI of VAS pain score lower than the preset value of 1.0. The muscle strength of triceps crus muscle in group IA was significantly better than that in group SA at leaving PACU and 4, 8 hours after operation (P < 0.001). There were no significant differences in quads femoral muscle strength, sufentanil dosage, PCIA compression times, and remedial analgesia.
Conclusion IPACK block combined with ACB can provide the same postoperative analgesic effect as SNB combined with ACB, while retaining the triceps muscle strength to the maximum extent, providing an alternative optimization scheme for postoperative analgesia after TKA. |
