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Less Pain Post TKA With Addition of Peripheral Nerve Blocks

Lower numeric rating scale pain scores on ambulation on postoperative days zero, one, and two

knee replacement

THURSDAY, April 19, 2018 (HealthDay News) -- Addition of an interspace between the popliteal artery and capsule of the posterior knee (IPACK) block and adductor canal block (ACB) to periarticular injection (PAI) is associated with less pain after total knee arthroplasty (TKA), according to a study presented at the 2018 World Congress on Regional Anesthesia and Pain Medicine, held from April 19 to 21 in New York City.

David Kim, M.D., from the Hospital for Special Surgery in New York City, and colleagues conducted a double-blind trial involving patients undergoing TKA who were randomized to either a PAI (control; 43 patients) or an IPACK with an ACB and modified PAI injection (intervention; 43 patients).

The researchers found that intervention patients reported lower numeric rating scale pain scores on ambulation than the control group on postoperative day (POD) one (1.7 versus 5.0; P < 0.001); significant differences were also seen on PODs zero and two (1.7 versus 5.2 [P < 0.001] and 4.5 versus 5.5 [P = 0.025], respectively). Significantly lower pain scores were also reported after physical therapy on POD zero and one in the intervention group (1.9 and 1.4, respectively; P < 0.001). Patients who received the intervention also had less opioid consumption, less intravenous opioids, and less intravenous patient controlled analgesia.

"This study strongly supports addition of IPACK block and ACB to a multimodal analgesic pathway," the authors write.

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