Combined adductor canal block and infiltration in the space between popliteal artery and posterior capsule of the knee block (IPACK) versus combined genicular nerve block and IPACK in total knee arthroplasty

Background & objective: Total knee arthroplasty (TKA) causes postoperative discomfort hindering recovery. Effective analgesia aids early rehabilitation and reduces falls. We compare the effectiveness of the conjunction of ACB + IPACK blocks versus GNB + IPACK blocks in providing postoperative pain relief and early recovery following TKA. Methodology: 40 participants were randomly allocated to two comparable sets received either combined ACB by 10 mL bupivacaine 0.25% and IPACK block by 20 mL of bupivacaine 0.25% or combined GNB using a total of 15 mL bupivacaine 0.25% and IPACK block using 20 mL of bupivacaine 0.25%. Time to first rescue analgesic dose, postoperative pain using NRS, total nalbuphine consumption, and risk of falls using Timed Up and Go (TUG) test on the consecutive two days after surgery were evaluated. Results: The GNB+IPACK group experienced a delayed time to the first rescue analgesic dose, lower total nalbuphine intake, reduced pain scores, earlier mobilization and decreased fall risk on the first and second postoperative days compared to the ACB+IPACK group with significant P-values. Conclusion: Combined GNB + IPACK blocks provided superior analgesia, reduced opioid consumption, better motor sparing, earlier ambulation, and decreased falls compared to ACB+IPACK blocks in postoperative TKA patients. Abbreviations: IPACK: the space between the popliteal artery and the posterior capsule of the knee Keywords: Adductor Canal Block; Analgesia; Genicular Nerve Block; IPACK; Regional anesthesia; Total Knee Arthroplasty; Opioids Citation: Abdelrahman Elkfafi SM, Ahmed Ghallab MA, Fawzy HM, Samir GM, Hashim RM. Combined adductor canal block and infiltration in the space between popliteal artery and posterior capsule of the knee block (IPACK) versus combined genicular nerve block and IPACK in total knee arthroplasty. Anaesth. pain intensive care 2025;29(2):261-269. DOI: 10.35975/apic.v29i2.2714 Received: July 30, 2024; Reviewed: October 26, 2024; Accepted: February 04, 2025