Ipack block knee3/20/2023 ![]() ![]() Objective: To describe analgesic control, opioid consumption, and mobility of patients scheduled for TKA using IPACK block as adjunct analgesic to the femoral block. The infiltration between popliteal artery and capsule of the knee (IPACK) block is a promising emerging analgesic technique. With conventional peripheral blocking techniques for the posterior compartment, foot drop, and distal motor deficit have been reported. Abstract: Introduction: Pain control in total knee arthroplasty (TKA) is a determining factor in the patient's rehabilitation process.As there is no muscle weakness so the patient can participate in physical therapy early. The main advantage of PENG block is that it provides better analgesia of the hip without causing any muscle weakness. These blocks also result in incomplete analgesia to the hip as here is sparing of few articular branches to the hip. These blocks result in weakness of quadriceps muscles and thus predispose to fall. Femoral nerve block, fascia iliaca compartment block, or lumbar plexus block have been used to manage post-operative analgesia in hip surgeries. It is performed in supine position by depositing 15-20 ml of local anesthetic in the plane between the psoas tendon and the pubic ramus under direct ultrasound visualization. PENG block is indicated for anterior hip arthroplasties, lateral hip arthroplasties, and for hip fractures. PENG block: The pericapsular nerve group (PENG) block is an interfascial plane block aiming to block articular branches supplied by femoral, obturator, and accessory obturator nerves. A total of 12 cc to 30 cc of local anesthetic is injected. A needle tip is placed next to the nerve roots. A needle is then placed in-plane or out-of-plane and directed toward the nerves. At the C6 nerves of the brachial plexus are visualized in a vertical orientation within the interscalene groove. The subclavian artery is identified by directing the beam towards the first rib. The carotid artery and internal jugular vein are visualized. A probe is placed in a transverse position with its long axis across the neck just above the clavicle if using ultrasound. Sternal notch, the sternal and clavicular heads of the sternocleidomastoid muscle, and clavicle are identified and marked. For positioning, the patient is placed in a supine position with the head turned away from the side of the block. Interscalene block: anesthetizes nerve roots from the cervical plexus (C3, C4, supraclavicular nerve) and upper and middle trunks of the brachial plexus (C5-C7). Also, intravenous access should be obtained due to the risk of potential complications like vasovagal events, local anesthetic toxicity, and the possible use of general anesthetics. ![]() Following the history and physical, the patient should be made familiar with the risks, benefits, and care needed during the recovery phase of the block.įor patients that are receiving a nerve block for a surgical procedure, they should follow the same fasting guidelines for the surgery as it may be necessary for deep sedation to be used in cases of an inadequate block. Studies show that patients with preexisting sensory or motor deficits may be more likely to develop new deficits following a block than patients without preexisting deficits. A thorough physical exam is prudent as well to determine preexisting sensory or motor deficits in the distribution of the block. Taking a detailed medical history is necessary to determine conditions like coagulopathy or respiratory compromise that may impact the decision to perform a block.
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