Comparison between Ultrasound Guided Femoral Nerve Block versus IPACK Block (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) in Patients Undergoing Total Knee Replacement on Postoperative Ambulation and Pain

Abstract Background Total knee replacement (TKR) is a well-known popular surgical procedure for knee diseases, including end-stage knee osteoarthritis that causes severe postoperative pain and prolonged immobility. TKR is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. Aim of the Work The current study aims to assess the IPACK block concerning postoperative ambulation as a primary outcome and analgesic efficacy as a secondary outcome when compared with femoral nerve block following TKR. Patients and Methods This study is a randomized controlled clinical trial was conducted on 40 random patients who were scheduled to undergo total knee replacement and were divided into 2 equal groups: Group A: Patients in group A (n = 20) received spinal anesthesia followed by FNB block at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions, Group B: Patients in group B (n = 20) received spinal anesthesia followed by IPACK at the beginning of the operation with 20ml bupivacaine (0.25%) under complete aseptic conditions. Results As for the comparison between effect of the IPACK block and FNB regarding ambulation and postoperative pain in TKR, it showed that there is significance regarding ambulation that was delayed in FNB than IPACK using TUG test and 10-min walk test, but regarding VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative. Conclusion Our study showed that there was delayed ambulation in FNB than in IPACK using the TUG test and 10-min walk test, but regarding the VAS score that was used to assess postoperative pain and its intensity, it showed that FNB has more analgesic effect concerning IPACK block with less total analgesics consumption (in mg.) over 24-hour period post-operative.