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This article describes the use of an infiltration between the popliteal artery and capsule of the knee joint (IPACK) to diagnose an entrapment neuropathy of the tibial nerve (TN) in a patient presenting with chronic neuropathic pain in the medial posterior compartment of the left knee, with a previous electromyography showing no evidence of tibial or common peroneal nerve neuropathy. After a positive sciatic nerve block, the patient was evaluated for a TN block, cancelled due to the presence of an abnormal leash of vessels wrapping around the nerve. For this reason, the patient was submitted to a diagnostic IPACK. A negative IPACK suggested that a compression of the TN at the popliteal fossa was the most likely source of the symptoms. After surgical decompression of the TN nerve at the popliteal fossa, the patient's symptoms decreased substantially.
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http://dx.doi.org/10.2217/pmt-2020-0104 | DOI Listing |
Anaesthesiol Intensive Ther
August 2025
Department of Organization and Management in Health Care, Poznań University of Medical Sciences, Poznań, Poland.
Introduction: Total knee arthroplasty (TKA) is associated with severe pain. We examined whether an ultrasound-guided, single-injection L2 erector spinae plane block could improve analgesia compared to an ultrasound-guided iPACK (infiltration between the popliteal artery and capsule of the knee) block with adductor canal block (ACB) in patients undergoing TKA under spinal anesthesia.
Material And Methods: Ninety patients aged 65-89 years of both sexes (ASA I-III) scheduled for TKA were randomly allocated to receive iPACK block (ropivacaine 0.
Medicine (Baltimore)
August 2025
Department of Anesthesiology and Reanimation, Faculty of Medicine, Bahçeşehir University, Göztepe Medical Park Hospital, Istanbul, Turkiye.
Total knee arthroplasty (TKA) is associated with significant postoperative pain, managed with multimodal analgesia, including regional anesthesia techniques like peripheral nerve blocks. The knee joint's innervation by both sacral and lumbar plexuses often necessitates combined blocks for effective analgesia. This study aimed to compare the effects of suprainguinal fascia iliaca block (SIFIB) and a combination of popliteal artery and posterior knee capsule injection (IPACK) with adductor canal block (ACB) on 24-hour postoperative pain scores, as well as their impact on inflammatory markers and biochemical indicators of myotoxicity.
View Article and Find Full Text PDFBMC Anesthesiol
July 2025
Department of Orthopedics, Xijing Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China.
Background: Postoperative pain is an important complication that impedes the functional recovery of the total knee arthroplasty (TKA). A variety of analgesic methods including the popliteal artery and capsule of the posterior knee block (IPACK), local infiltration analgesia (LIA) and peripheral cutaneous nerve (PCN) block have been applied via intraoperative or postoperative local injection for alleviating pain after TKA. The purpose of this study was to compare the analgesic effect and function outcome of two local anesthetic methods for reducing postoperative pain after TKA.
View Article and Find Full Text PDFMed Sci Monit
May 2025
Department of Anesthesiology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong, China.
BACKGROUND The interspace between the popliteal artery and posterior capsule of the knee block (IPACK) combined with adductor canal block (ACB) has short-term analgesic effect after arthroscopic knee surgery(AKS), and prolonging the duration of analgesia is very important for patients to recover quickly after surgery. The purpose of this study was to investigate whether perineural dexmedetomidine (DEX) or intravenous can prolong the analgesic time of IPACK and ACB, and ultimately promote the postoperative rehabilitation of patients undergoing AKS. MATERIAL AND METHODS In this randomized controlled trial, 102 eligible AKS patients were allocated to 3 groups: perineural DEX with ropivacaine for Group E (n=34), intravenous DEX for Group I (n=34), and standard IPACK-ACB (ropivacaine alone) for Group C (n=34).
View Article and Find Full Text PDFAm J Sports Med
May 2025
Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.
Background: Efforts to decrease pain, improve early rehabilitation, and reduce opioid consumption have prompted a focus on peripheral nerve blocks for pain management after anterior cruciate ligament reconstruction (ACLR). The commonly used adductor canal block (ACB) might not provide sufficient postoperative pain control because of its lack of coverage of the posterior aspect of the knee. The addition of the IPACK (interspace between the popliteal artery and the capsule of the posterior knee) block, which targets this area, to the standard ACB could potentially provide better pain control after ACLR over the current standard of care.
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