Journal of clinical anesthesia | 2021
The analgesic efficacy of iPACK after knee surgery: A systematic review and meta-analysis with trial sequential analysis.
Abstract
STUDY OBJECTIVE\nThe 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.\n\n\nDESIGN\nSystematic review, meta-analysis and trial sequential analysis.\n\n\nSETTING\nOperating room, postoperative recovery area and ward, up to 24 postoperative hours.\n\n\nPATIENTS\nPatients scheduled for knee surgery under general or spinal anaesthesia.\n\n\nINTERVENTIONS\nWe searched five electronic databases for randomized controlled trials comparing iPACK with a control group.\n\n\nMEASUREMENTS\nThe primary outcome was rest pain score scores on a visual analogue scale (VAS) of 0-10 at 12\xa0h 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\xa0h and 24\xa0h, and functional outcomes including ambulation distance and range of motion at discharge.\n\n\nMAIN RESULTS\nSix 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\xa0h, with a mean difference (95% CI) of -1.0 (-1.5 to -0.5), I2\xa0=\xa093%, p\xa0=\xa00.0003, without subgroup differences for postoperative multimodal analgesia (p\xa0=\xa00.15). 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.\n\n\nCONCLUSIONS\nThere is moderate level evidence that iPACK might provide analgesia for posterior pain after total knee arthroplasty when compared with a control group at 12\xa0h, 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.