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THE ULTRASOUND-GUIDED ADDUCTOR CANAL BLOCK COMBINED WITH IPACK FOR MOTOR SPARING ANALGESIA TO THE KNEE: IS IT REALLY POSSIBLE?
Author(s): ,
Scimia, P.
Affiliations:
Hospital of Cremona, Department of Anesthesia and Perioperative Medicine, Cremona, Italy
,
Giordano, C.
Affiliations:
Hospital of Cremona, Department of Anesthesia and Perioperative Medicine, Cremona, Italy
,
Basso Ricci, E.
Affiliations:
, Department of Anesthesia and Perioperative Medicine, Cremona, Italy
,
Budassi, P.
Affiliations:
Hospital of Cremona, Department of Orthopaedics and Traumatology, Cremona, Italy
Fusco, P.*
Affiliations:
, Department of Anesthesia and Intensive Care Unit, L'Aquila, Italy
ESRA Academy. Fusco P. Sep 13, 2017; 190966; 174 Topic: Peripheral Nerve Blocks
Dr. Pierfrancesco Fusco
Dr. Pierfrancesco Fusco

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Abstract
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Background and Aims:

Total Knee arthroplasty (TKA) is often associated with severe postoperative pain, which may compromise rehabilitation and hospital disharge. Femoral nerve block provides effective analgesia but is associated with postoperative quadriceps muscle weakness, which may limit ambulation making the rehabilitation results unsatisfactory. Although, the ultrasound-guided Adductor Canal Block (US-ACB) has the advantage of providing localized motor-sparing analgesia, it doesn’t provide pain relief to the posterior aspect of the knee. This pain could be decreased by addition of the ultrasound-guided local anaesthetic infltration of the interspace between the popliteal artery and the capsule of the posterior Knee (US-IPACK).

Methods:

A 75-years-old patient, ASA 3, underwent TKA. Written informed consent was obtained. Previous sedation with Midazolam 0,02 mg/kg i.v., we performed US-IPACK by injecting 0,25% Levobupivacaine 20 ml. TKA was performed under spinal anaesthesia with 0,5% Levobupivacaine 12 mg. Tourniquet was used and released before closure. After surgery, a continuous US-ACB was performed by injecting 0,25% Levobupivacaine 20 ml plus 4 mg of Dexamethasone within the adductor canal, followed by catheter infusion at a rate of 8 ml/h of 0.2% Levobupivacaine, which was discontinued 72 hours postoperatively.

 

 

Results:

Patient reported long-lasting pain relief allowing earlier and more effective rehabilitation. In the first 72 hours after surgery only 3 g of acetaminophen were administered, with rescue dose of ketorolac 30 mg as needed. No opioids were required.

 

Conclusions:

Based on our results, we believe US-ACB/IPACK could provide good quality postoperative analgesia with reduced motor weakness, improving physical therapy performance and time to disharge with excellent patient satisfaction.

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