Comparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched study
Abstract Background Nerve blocks are effective in reducing postoperative opioid use and enhancing rehabilitation following total knee arthroplasty. However, few studies compare the analgesic efficacy and functional recovery of adductor canal block (ACB) combined with infiltration between the poplite...
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BMC
2025-05-01
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| Online Access: | https://doi.org/10.1186/s12871-025-03112-z |
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| author | Chao-Hsien Sung Jen-Hao Liu Chi-Feng Hung Chun-Hsien Fu |
| author_facet | Chao-Hsien Sung Jen-Hao Liu Chi-Feng Hung Chun-Hsien Fu |
| author_sort | Chao-Hsien Sung |
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| description | Abstract Background Nerve blocks are effective in reducing postoperative opioid use and enhancing rehabilitation following total knee arthroplasty. However, few studies compare the analgesic efficacy and functional recovery of adductor canal block (ACB) combined with infiltration between the popliteal artery and the capsule of the knee (iPACK) versus sciatic and femoral nerve blocks (S + F). This study hypothesized that ACB combined with iPACK (A + I) provides comparable analgesia to S + F with superior motor recovery. Methods Data were obtained from a prospectively maintained acute pain service database. After exclusion criteria were applied, 126 patients were analyzed. Propensity-score matching balanced baseline characteristics between the A + I and S + F groups. Numeric rating scale (NRS) scores at different time points were primary outcome. Motor function analysis, including the motor blockade, maximum flexion angle and time to ambulation were secondary outcomes. Results After propensity score matching, patients in the A + I group reported significantly lower NRS pain scores in the post-anesthetic care unit (1.00 ± 0.72 vs. 1.52 ± 1.34; P = 0.026) and on postoperative day 1 at rest (0.66 ± 0.71 vs. 1.07 ± 0.95; P = 0.025) and during movement (1.75 ± 0.75 vs. 2.43 ± 1.19; P = 0.002). Movement-associated pain on postoperative day 2 was also lower in the A + I group (1.45 ± 0.66 vs. 2.34 ± 0.91; P < 0.001). The A + I group exhibited significantly less motor blockade (P < 0.001) and achieved earlier ambulation (1551.75 ± 379.98 vs. 2031.95 ± 764.77 min; P < 0.001). Conclusions The A + I regimen demonstrated superior analgesic efficacy, reduced motor blockade, and earlier ambulation compared to S + F in TKA patients. These findings support the use of A + I for improved recovery. Trial registration This trial was registered before collection of data and analysis at ClinicalTrials.gov (NCT06521619). Date of registration: 2024-07-26. |
| format | Article |
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| institution | DOAJ |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Anesthesiology |
| spelling | doaj-art-66769eec13764fc8a32e7cf938d63b992025-08-20T03:10:32ZengBMCBMC Anesthesiology1471-22532025-05-0125111110.1186/s12871-025-03112-zComparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched studyChao-Hsien Sung0Jen-Hao Liu1Chi-Feng Hung2Chun-Hsien Fu3Division of Anesthesiology, Fu Jen Catholic University Hospital, Fu Jen Catholic UniversityDivision of Anesthesiology, Fu Jen Catholic University Hospital, Fu Jen Catholic UniversitySchool of Medicine, Fu Jen Catholic UniversityDivision of Anesthesiology, Fu Jen Catholic University Hospital, Fu Jen Catholic UniversityAbstract Background Nerve blocks are effective in reducing postoperative opioid use and enhancing rehabilitation following total knee arthroplasty. However, few studies compare the analgesic efficacy and functional recovery of adductor canal block (ACB) combined with infiltration between the popliteal artery and the capsule of the knee (iPACK) versus sciatic and femoral nerve blocks (S + F). This study hypothesized that ACB combined with iPACK (A + I) provides comparable analgesia to S + F with superior motor recovery. Methods Data were obtained from a prospectively maintained acute pain service database. After exclusion criteria were applied, 126 patients were analyzed. Propensity-score matching balanced baseline characteristics between the A + I and S + F groups. Numeric rating scale (NRS) scores at different time points were primary outcome. Motor function analysis, including the motor blockade, maximum flexion angle and time to ambulation were secondary outcomes. Results After propensity score matching, patients in the A + I group reported significantly lower NRS pain scores in the post-anesthetic care unit (1.00 ± 0.72 vs. 1.52 ± 1.34; P = 0.026) and on postoperative day 1 at rest (0.66 ± 0.71 vs. 1.07 ± 0.95; P = 0.025) and during movement (1.75 ± 0.75 vs. 2.43 ± 1.19; P = 0.002). Movement-associated pain on postoperative day 2 was also lower in the A + I group (1.45 ± 0.66 vs. 2.34 ± 0.91; P < 0.001). The A + I group exhibited significantly less motor blockade (P < 0.001) and achieved earlier ambulation (1551.75 ± 379.98 vs. 2031.95 ± 764.77 min; P < 0.001). Conclusions The A + I regimen demonstrated superior analgesic efficacy, reduced motor blockade, and earlier ambulation compared to S + F in TKA patients. These findings support the use of A + I for improved recovery. Trial registration This trial was registered before collection of data and analysis at ClinicalTrials.gov (NCT06521619). Date of registration: 2024-07-26.https://doi.org/10.1186/s12871-025-03112-zAdductor canal blockiPACKTotal knee arthroplastiesPostoperative analgesiaMotor function recoveriesNerve block |
| spellingShingle | Chao-Hsien Sung Jen-Hao Liu Chi-Feng Hung Chun-Hsien Fu Comparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched study BMC Anesthesiology Adductor canal block iPACK Total knee arthroplasties Postoperative analgesia Motor function recoveries Nerve block |
| title | Comparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched study |
| title_full | Comparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched study |
| title_fullStr | Comparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched study |
| title_full_unstemmed | Comparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched study |
| title_short | Comparative analysis of adductor canal block combined with iPACK block versus femoral combined with sciatic nerve blocks: a propensity score matched study |
| title_sort | comparative analysis of adductor canal block combined with ipack block versus femoral combined with sciatic nerve blocks a propensity score matched study |
| topic | Adductor canal block iPACK Total knee arthroplasties Postoperative analgesia Motor function recoveries Nerve block |
| url | https://doi.org/10.1186/s12871-025-03112-z |
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