Objective: Peripheral nerve blocks have gained popularity in recent years because of advancements in ultrasound-guided techniques and their proven effectiveness in providing targeted analgesia. In knee surgeries, combining a femoral nerve block or adductor canal block (ACB) with a subgluteal sciatic block, popliteal sciatic block, or the infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block has been shown to offer superior analgesia due to the comprehensive sensory innervation of the knee region.
Methods: This study was designed to compare the analgesic efficacy of ACB + IPACK block combination with single-dose epidural analgesia in arthroscopic knee surgery. The primary outcome was to assess analgesic efficacy at different time points (1st, 8th, and 24th hours post-block administration) between the ACB + IPACK block combination and epidural analgesia. Secondary outcomes included chronic pain outcomes at the 3-month post-surgery mark, discharge times, patient mobilization times, and postoperative analgesic requirements. This prospective observational study was conducted between August 15, 2022, and February 15, 2023. The study included patients over the age of 18 years who were scheduled to undergo arthroscopic knee surgery under spinal anesthesia and who had no limitations in cooperation or orientation.
Results: Both IPACK, ACB, and epidural analgesia demonstrated comparable efficacy in providing pain relief in arthroscopic knee surgery patients. The block group showed comparable postoperative analgesia to the epidural group at the 8th and 24th h, whereas the combined spinal epidural group provided more effective analgesia at the 1st h. Additionally, the block group was associated with shorter mobilization times than the epidural group. No significant differences were found in discharge times or chronic pain at 3 months between the two groups (p>0.05).
Conclusion: Both IPACK, ACB, and epidural analgesia can be effective options for managing postoperative pain in patients undergoing arthroscopic knee surgery. The findings of this study suggest that IPACK, ACB, and epidural analgesia can be effective options for managing postoperative pain in patients undergoing arthroscopic knee surgery. However, further randomized controlled trials are needed to confirm these findings.