Motor-sparing peripheral nerve blocks, such as the infiltration between the popliteal artery and capsule of the knee (IPACK) and the adductor canal block (ACB), are promising analgesic pathways but supporting literature remains rare. Periarticular injections (PAIs) are becoming an essential multimodal joint analgesia. We hypothesized that ACB and IPACK would lower pain on ambulation on postoperative day (POD) 1 compared to PAI alone.
This double-blinded randomized controlled trial included 50 patients undergoing ACL repair. Patients either received (1) a PAI (control group, n = 26) or (2) an iPACK with an ACB (intervention group, n = 24). The primary outcome was pain on ambulation on POD 1. Secondary outcomes included numeric rating scale (NRS) pain scores, patient satisfaction, and opioid consumption.
The intervention group reported significantly lower pain scores on ambulation than the control group on POD 1 (difference in means [95% confidence interval]; P < .001). In addition, pain scores on ambulation on POD 2 for group B (3.5 [-4.3 to -2.7]) and POD 2 for group A (1.0 [1.9 to 0.1]; with P = .033) were significantly lower. Patients in the intervention group were more satisfied, had less intravenous opioid consumption (post anesthesia care unit, P = .028), and reduced need for intravenous patient-controlled analgesia for the first 24 hours (P = .037).
The addition of iPACK and ACB significantly improves analgesia and reduces opioid consumption after ACL repair compared to PAI alone. This study strongly supports iPACK and ACB use within a multimodal analgesic pathway.