Comparative efficacy of ultrasound-guided adductor canal block with infiltration between the popliteal artery and the capsule of the knee block versus adductor canal block alone for post-operative analgesia after total knee arthroplasty: A prospective observational study

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Background: Total knee arthroplasty (TKA) is associated with post-operative pain, which may delay ambulation, restrict physiotherapy and increase analgesic use. Adductor canal block (ACB) provides predominantly sensory analgesia, preserving quadriceps function, but posterior knee pain may persist. The Infiltration between the Popliteal Artery and the Capsule of the Knee (IPACK) block targets the posterior knee capsule using a motor-sparing approach. Aims and Objectives: This study aimed to compare ultrasound-guided ACB combined with IPACK block versus ACB alone for post-operative analgesia and early functional recovery after TKA. Materials and Methods: This prospective observational study included 52 patients undergoing primary unilateral TKA for osteoarthritis. Patients were divided equally into two groups: ACB with an IPACK block and ACB alone. All patients received spinal anesthesia and standard multimodal post-operative analgesia. Visual Analog Scale (VAS) scores were assessed at 4, 8, 12, 24, and 48 h. Time to first rescue analgesia, post-operative range of motion (ROM), ambulation distance, adverse effects, duration of surgery and hospital stay were recorded. Results: Baseline age, sex distribution and pre-operative knee ROM were comparable between groups. The combined-block group had lower VAS scores at 4, 8, 12, and 24 h, with no significant difference at 48 h. Time to first rescue analgesia was longer in the combined-block group. Post-operative day 2 ROM and day 3 ambulation distance were better, and hospital stay was shorter. Adverse events were similar. Conclusion: Addition of the IPACK block to ACB improved early post-operative analgesia, delayed rescue analgesic requirement and enhanced functional recovery without increasing observed adverse effects.

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