Effect of Continuous Adductor Canal Block Versus Continuous Adductor Canal Block With Additional Infiltration Between The Popliteal Artery and Capsule of The Knee (IPACK) After Arthroscopic Knee Surgeries

Enhanced recovery after arthroscopic knee surgery is gaining popularity in orthopedic surgeries. Motor preservation with adequate analgesia has become the optimal postoperative goal, enabling earlier physical therapy, faster recovery, and early hospital discharge. Spinal anesthesia for knee arthroscopy has favorable outcome effects compared with general anesthesia. The positive physiological effects of the provided sympathetic blockade with less blood loss, increased leg blood flow, and better initial pain relief explain this.

An ideal nerve block that targets the sensory nerves and spares the motor function can facilitate early ambulation and rehabilitation, a major goal for patients undergoing arthroscopic knee surgery.

A novel technique for posterior knee block, known as the infiltration between the popliteal artery and capsule of the knee (IPACK) block combined with continuous adductor canal block (CACB) would reduce opioid requirements.

Inclusion criteria

• Age from 21 to 65 years.
• Both sexes.
• American Society of Anesthesiologists (ASA) Physical Status Class I to II.
• Patients with successful spinal anesthesia.
• Patients scheduled for elective arthroscopic knee surgery for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repair.

Exclusion criteria

• Declining to give written informed consent.
• History of allergy to the medications used in the study.
• Contraindications to regional anesthesia (including coagulopathy and local infection).
• Polytrauma patients having lower limb fractures.
• Patients with pre-existing myopathy or neuropathy on the operating limb.
• Patients with diabetes mellitus.
• Psychiatric disorder.
• Morbid obesity [body mass index (BMI) > 45kg/m2].
• Complicated Surgery.