Capsular block versus IPACK block: comparison in pain management in patients with total knee replacement

Abstract

Total knee replacement (TKR) is a surgical procedure indicated in patients with severe osteoarthritis (grade III - IV) of the joint. Various analgesia techniques have been developed to reduce postoperative pain in TKR. Objective: To evaluate the efficacy of capsular block versus infiltration block between the popliteal artery and the knee capsule (IPACK) in the management of pain in patients treated with TKR. Materials and methods: An observational, analytical, prospective cohort study was carried out for 10 months in 20 patients with severe knee osteoarthritis, corroborated by imaging studies. The ultrasound-guided IPACK block with levobupivacaine was applied to 10 patients, and the other 10 patients had the block applied to the posterior capsule of the knee with Ranawat's mixture after cementation of the prosthesis during surgery. In a second time, at 24 and 48 hours postoperatively, an evaluation instrument was applied to determine the functionality of the knee considering the degrees of flexion and the level of analgesia through the visual analog pain scale. Results: There were no significant differences between both anesthetic techniques, however the degrees of flexion with the capsular block were higher with respect to the IPACK block as well as with the visual analog pain scale (VAS). Conclusion: The two blocks turn out to be efficient for the management of postoperative pain in patients with knee joint replacement.