TY - JOUR
T1 - The analgesic efficacy of iPACK after knee surgery
T2 - A systematic review and meta-analysis with trial sequential analysis
AU - Albrecht, Eric
AU - Wegrzyn, Julien
AU - Dabetic, Aleksandar
AU - El-Boghdadly, Kariem
N1 - Funding Information:
KE or his institution received grant, educational or travel funding from Ambu, GE Healthcare and Fisher and Paykel.
Funding Information:
EA has received grants from the Swiss Academy for Anaesthesia Research (SACAR), Lausanne, Switzerland (no grant numbers attributed), from B. Braun Medical AG, Sempach, Switzerland (no grant numbers attributed) and from the Swiss National Science Foundation to support his clinical research. EA has also received an honorarium from B. Braun Medical AG Switzerland, from Sintetica Ltd. UK and MSD AG Switzerland.
Funding Information:
This work was supported by departmental funding (Department of Anaesthesia, Lausanne University Hospital , Lausanne, Switzerland).
Publisher Copyright:
© 2021 The Author(s)
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - STUDY OBJECTIVE: The novel infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to relieve posterior knee pain after knee surgery. The study objective is to determine whether iPACK provides analgesia after knee surgery when compared with a control group. DESIGN: Systematic review, meta-analysis and trial sequential analysis. SETTING: Operating room, postoperative recovery area and ward, up to 24 postoperative hours. PATIENTS: Patients scheduled for knee surgery under general or spinal anaesthesia. INTERVENTIONS: We searched five electronic databases for randomized controlled trials comparing iPACK with a control group. MEASUREMENTS: The primary outcome was rest pain score scores on a visual analogue scale (VAS) of 0-10 at 12 h postoperatively, analysed according to the nature of surgery (total knee arthroplasty vs. anterior cruciate ligament reconstruction) and the use of multimodal analgesia. Secondary outcomes included rest and dynamic pain scores, intravenous morphine-equivalent consumption at 2 h and 24 h, and functional outcomes including ambulation distance and range of motion at discharge. MAIN RESULTS: Six trials involving 687 patients were included, all of which received total knee arthroplasty only. When compared with a control group, iPACK significantly reduced rest pain scores at 12 h, with a mean difference (95% CI) of -1.0 (-1.5 to -0.5), I2 = 93%, p = 0.0003, without subgroup differences for postoperative multimodal analgesia (p = 0.15). Secondary pain outcomes were inconsistently improved with iPACK. Functional outcomes were either similar between groups or had clinically unimportant differences. The overall quality of evidence was moderate. CONCLUSIONS: There is moderate level evidence that iPACK might provide analgesia for posterior pain after total knee arthroplasty when compared with a control group at 12 h, but was not associated with any other meaningful benefits. Based on these results, there is currently limited evidence supporting the use of iPACK as a complement to adductor canal block for analgesia after total knee arthroplasty.
AB - STUDY OBJECTIVE: The novel infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to relieve posterior knee pain after knee surgery. The study objective is to determine whether iPACK provides analgesia after knee surgery when compared with a control group. DESIGN: Systematic review, meta-analysis and trial sequential analysis. SETTING: Operating room, postoperative recovery area and ward, up to 24 postoperative hours. PATIENTS: Patients scheduled for knee surgery under general or spinal anaesthesia. INTERVENTIONS: We searched five electronic databases for randomized controlled trials comparing iPACK with a control group. MEASUREMENTS: The primary outcome was rest pain score scores on a visual analogue scale (VAS) of 0-10 at 12 h postoperatively, analysed according to the nature of surgery (total knee arthroplasty vs. anterior cruciate ligament reconstruction) and the use of multimodal analgesia. Secondary outcomes included rest and dynamic pain scores, intravenous morphine-equivalent consumption at 2 h and 24 h, and functional outcomes including ambulation distance and range of motion at discharge. MAIN RESULTS: Six trials involving 687 patients were included, all of which received total knee arthroplasty only. When compared with a control group, iPACK significantly reduced rest pain scores at 12 h, with a mean difference (95% CI) of -1.0 (-1.5 to -0.5), I2 = 93%, p = 0.0003, without subgroup differences for postoperative multimodal analgesia (p = 0.15). Secondary pain outcomes were inconsistently improved with iPACK. Functional outcomes were either similar between groups or had clinically unimportant differences. The overall quality of evidence was moderate. CONCLUSIONS: There is moderate level evidence that iPACK might provide analgesia for posterior pain after total knee arthroplasty when compared with a control group at 12 h, but was not associated with any other meaningful benefits. Based on these results, there is currently limited evidence supporting the use of iPACK as a complement to adductor canal block for analgesia after total knee arthroplasty.
KW - Analgesia
KW - Knee arthroplasty
KW - Peripheral nerve block
KW - Postoperative pain
UR - http://www.scopus.com/inward/record.url?scp=85107319321&partnerID=8YFLogxK
U2 - 10.1016/j.jclinane.2021.110305
DO - 10.1016/j.jclinane.2021.110305
M3 - Article
C2 - 33930796
AN - SCOPUS:85107319321
SN - 1873-4529
VL - 72
SP - 110305
JO - Journal of clinical anesthesia
JF - Journal of clinical anesthesia
M1 - 110305
ER -