Postoperative analgesic effectiveness of combined ultrasound guided adductor canal block with ipack (infiltration between popliteal artery and posterior knee capsule) and adductor canal block alone in patients undergoing knee arthroscopy: An observational

Background: Peripheral nerve blocks are ideally suited for lower extremity ambulatory surgery because of potential to block pain pathways at multiple levels. The objective of this observational studies was to assess theanalgesic characteristics of USG guided combined ACB with IPACKblock and ACB alone, in arthroscopic ACL reconstruction. Methods: This prospective observational study was conducted over a period of twenty months on 61 patients (18-65 years, ASA grade I, II, III) undergoing knee arthroscopic ACL reconstruction under spinal block who were divided into two groups. Group 1 (n=32) received combined USG guided ACB with IPACK and Group 2 (n=29) received USG guided ACB alone. Both groups received 20 ml of 0.2% Ropivacaine. Postoperative pain was assessedby VAS score at 2, 4, 8, 12, 18 and 24 hours. Results: VAS score were significantly lower in group 1 as compared to group 2 at 4, 8, 12 and 18 hours postoperatively. Mean duration of post-operative analgesia was significantly longer in group 1 than group 2 (16.5±4.57 hours vs. 10.3±2.01 hours). The difference between mean time to first rescue analgesia between the twogroups was statistically significant (p-value of <0.001). Difference in analgesic consumption in 24 hours was statistically significant between two groups. Conclusion: Combined USG guided adductor canal block with IPACK is superior to USG guided Adductor canal block alone with respect to postoperative pain scores, time to first rescue analgesia, total doses of rescue analgesia consumption and patient satisfaction. However, with regard to complications and side effects both groups were equivalent as no complication/side effect was noted in any of the groups