Comparison of the Popliteal Artery and the Capsule of the Posterior Knee (Ipack) Block and the Genicular Nerve Block in Primary Total Knee Arthroplasty a Prospective Randomized Trial

Abstract

Objectives: To compare the efficacy of genicular block and interspace between the popliteal artery and the posterior capsule (IPACK) block in the reduction of postoperative pain, the need for rescue analgesics, and the effects on a range of motion (ROM) in patients with TKA. Methods: This prospective randomized controlled study was carried out between February and May 2023. Based on the block method, 60 participants were divided into three equal groups. These groups included the IPACK block group (n=20), the genicular block group (n=20), and control group (n=20). Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Society score (KSS) and Oxford Knee score (OKS) were used for clinical evaluation in the postoperative period. Results: The KSS and OKS scores of the IPACK and GNB were significantly lower than the control group ( p <0.001, p <0.001). The timed up and go (TUG) values of the IPACK and GNB groups at 12th and 24th hour were significantly lower than the control group ( p <0.001, p <0.001). The Tramadol rescue values of the IPACK block and control groups were significantly higher than the GNB group ( p =0.028, p =0.001, respectively). The ROM values of the IPACK and GNB groups were significantly higher than the control group ( p <0.001, p <0.001). Conclusion: Both GNB and IPACK blocks had a significant positive impact on postoperative pain scores within the initial 24 hours following total knee arthroplasty (TKA). In comparison with IPACK, GNB had lower opioid consumption in the early postoperative period while also promoting better mobilization.