Skip to main content

Table 1 Characteristics of the study included

From: iPACK block (local anesthetic infiltration of the interspace between the popliteal artery and the posterior knee capsule) added to the adductor canal blocks versus the adductor canal blocks in the pain management after total knee arthroplasty: a systematic review and meta-analysis

Author, Year

Study design

Anesthesia and block timing

Composition of interventions

Composition of controls

Perioperative analgesia strategy

Primary outcome

DongHai Li, 2020

RCT

General anesthesia (pre-operation)

ACB + iPACK: ACB (20 ml of 0.2% ropivacaine, 2.0 mg/mL of epinephrine)

iPACK (20 ml of 0.2% ropivacaine, 2.0 mg/mL of epinephrine)

ACB (20 ml of 0.2% ropivacaine, 2.0 mg/mL of epinephrine)

Postoperative: ice compression devices; loxoprofen 60 mg PO bid; alprazolam 0.4 mg PO qd

Pain score (VAS score/morphine consumption)

Ambulation ability(the knee flexion angle/extension angle/quadriceps strength/patients’ daily ambulation

distance/knee function KSS/WOMAC physical function/TUG test)

Jason Ochroch, 2020

RCT

Spinal anesthesia (pre-operation)

ACB + iPACK: ACB (20 ml of 0.5% ropivacaine)

iPACK (20 ml of 0.5% ropivacaine)

ACB (20 ml of 0.5% ropivacaine)

Preoperative: Acetaminophen 1000 mg PO; Gabapentin 300 mg PO; Celecoxib 200 mg PO

Postoperative: Adductor canal catheter, ropivacaine 0.2% 8 mL/hour with demand bolus of 5 mL, lockout interval 30 min × 2 days; Acetaminophen 1000 mg PO every 8 h × 3 days; Celecoxib 200 mg PO every 12 h × 3 days; Gabapentin 300 mg PO every 12 h × 7 days; Oxycodone 5–10 mg PO every 4 h PRN

Pain score (Opioid consumption/Presence of posterior knee pain)

The quality of pain management (American Pain Society Patient Outcome Questionnaire)

Ambulation ability (ambulation distance/TUG test)

Ling Hu, 2020

RCT

General anesthesia (pre-operation)

ACB + iPACK: ACB (20 ml of 0.2%ropivacaine)

iPACK (15 ml of 0.2% ropivacaine)

ACB (25 ml of 0.375% ropivacaine)

Postoperative PCA (sufentanil 1ug/ml, background dose 2 ml/h, lockout interval 15 min × 2 days)

Pain score (VAS score/times of Intravenous parecoxib)

Ambulation ability (the range of movement/time of first ambulation after operation)

Matthew E. Patterson, 2020

RCT

General anesthesia (pre-operation)

ACB + iPACK ACB (20 ml of 0.25% ropivacaine with epinephrine 3 mg/mL)

iPACK (15 ml of ropivacaine 0.25% with epinephrine 3 mg/mL)

ACB (20 ml of 0.25% ropivacaine with epinephrine 3 mcg/mL)

Preoperative Pregabalin 150 mg PO

Postoperative Adductor canal catheter, ropivacaine 0.2% 8 mL/h × 2 days; Acetaminophen 1 g PO every 8 h while in hospital; Celecoxib 400 mg PO daily while in hospital; Gabapentin 150 mg PO every night while in hospital

Pain score (Pain scale scores at rest and during physical therapy/ opioid consumption)

Ambulation ability (Walk distance)

Min Li, 2019

RCT

Spinal anesthesia (post-operation)

ACB + iPACK ACB (20 ml of 0.33% ropivacaine)

iPACK (15 ml of 0.33% ropivacaine)

ACB (20 ml of 0.33% ropivacaine)

Preoperative flurbiprofen axetil 50 mg IV

Postoperative celecoxib 200 mg PO bid;

Pain score (NRS score/ nalbuphine consumption)

Ambulation ability (ambulation distance/maximal knee flexion)

QiuRu Wang, 2020

RCT

General anesthesia (pre-operation)

ACB + iPACK ACB (20 ml of 0.2% ropivacaine with epinephrine 2ug/mL)

iPACK (20 ml of ropivacaine 0.2% with epinephrine 2ug/mL)

ACB (20 ml of 0.2% ropivacaine with epinephrine 2ug/mL)

Preoperative celecoxib 200 mg PO bid;

Postoperative ice compression devices; celecoxib 200 mg PO bid; oxycodone 10 mg PO bid

Pain score (VAS score/ morphine consumption)

Ambulation ability (maximal knee flexion/ambulation distance/Muscle force)

R. Tak, 2020

RCT

Spinal anesthesia (unclear)

ACB + iPACK ACB (20 ml of 0.2% ropivacaine)

iPACK (20 ml of 0.2% ropivacaine)

ACB (20 ml of 0.2% ropivacaine)

Preoperative Celecoxib 200 mg PO; Gabapentin 300 mg PO

Postoperative paracetamol 1 g IV tid × 3 days;

afterward paracetamol 1 g PO tid; Gabapentin 300 mg PO qd × 4 weeks

pain score (VAS scores/opioid consumption)

Ambulation ability (ambulation distance/TUG test, 30 s chair stand test/sitting active extension lag

test/maximal knee flexion)

Li Shen, 2019

RCT

General anesthesia (pre-operation)

ACB + iPACK ACB (25 ml of 0.375% ropivacaine)

iPACK (30 ml of 0.2% ropivacaine)

ACB (25 ml of 0.375% ropivacaine)

Postoperative PCA (sufentanil 1ug/ml, background dose 2 ml/h with demand bolus of 4 ml, lockout interval 30 min × 2 days)

Pain score (VAS score/ sufentanil consumption/Press times of PCA)

Muscle force (Bromage score)

Ambulation ability (maximal knee flexion/time of off-bed/the time of first straight leg raising)

S. R. Sankineani, 2018

non-RCT

Spinal anesthesia (post-operation)

ACB + iPACK ACB (20 ml of 0.2%ropivacaine)

iPACK (15 ml of 0.2% ropivacaine)

ACB (20 ml of 0.2%ropivacaine)

Preoperative Celecoxib 200 mg PO; Gabapentin 300 mg PO

Postoperative paracetamol 1 g IV tid × 3 days;

afterward paracetamol 1 g PO tid; Gabapentin 300 mg PO qd × 4 weeks

Pain score (VAS score)

Ambulation ability (ambulation distance/ the range

of movement)

XingFeng Zhou, 2020

RCT

General anesthesia (pre-operation)

ACB + iPACK ACB (25 ml of 0.25%ropivacaine)

iPACK (30 ml of 0.25% ropivacaine)

ACB (25 ml of 0.25%ropivacaine)

Postoperative: PCA (sufentanil 1ug/ml × 2 days)

Pain score (VAS score)

Ambulation ability (maximal knee flexion/ the time of first straight leg raising/time of off-bed)

YuQuan Li, 2020

non-RCT

General anesthesia (pre-operation)

ACB + iPACK ACB (30 ml of 0.375% ropivacaine)

iPACK (30 ml of 0.2% ropivacaine)

ACB (30 ml of 0.375% ropivacaine)

Postoperative PCA (sufentanil 1ug/ml, background dose 2 ml/h with demand bolus of 4 ml, lockout interval 30 min × 2 days)

Pain score (VAS score/ Press times of PCA)

Ambulation ability (Bromage score)

Chutikant Vichainarong 2020

RCT

Spinal anesthesia (pre-operation)

CACB + iPACK + LIA CACB (20 mL of 0.25%

levobupivacaine. Levobupivacaine 0.15% was continuously

dripped at 5 mL/hour via pump)

iPACK (20 mL of 0.25% levobupivacaine)

LIA (levobupivacaine 100 mg, ketorolac 30 mg, epinephrine 0.3 mg diluted to a total volume of 80

mL)

CABA + LIA CACB (20 mL of 0.25%

levobupivacaine. Levobupivacaine 0.15% was continuously

dripped at 5 mL/hour via pump)

LIA (levobupivacaine 100 mg, ketorolac 30 mg, epinephrine 0.3 mg diluted to a total volume of 80

mL)

Preoperative Acetaminophen 650 mg PO; Celecoxib 400 mg PO

Postoperative CABA;15 mg ketorolac IV; 650 mg

acetaminophen PO. q6h; 400 mg Celebrex PO. half a tablet of tramadol hydrochloride/acetaminophen PO. daily

If patients presented with persisting pain,2 mg of intravenous morphine as rescue therapy

Morphine consumption within 24 h

numerical rating scale pain scores

incidence of posterior knee pain

performance test results

patient satisfaction

length of stay

adverse events

Tayfun Et 2022

RCT

Spinal anesthesia (post-operation)

ACB + iPACK ACB (20 mL of 0.5% bupivacaine)

iPACK (20 mL of 0.5% bupivacaine)

ACB (20 mL of 0.5% bupivacaine)

Preoperatively Acetaminophen 1000 mg PO;

diclofenac sodium 75 mg PO

Postoperatively acetaminophen (1 g IV every 6 h, 4 doses);

diclofenac (50 mg PO. tid, 25 mg for ≥ 75 years of age);

tramadol 100 mg IV as a rescue analgesia when patient

complained of pain with NRS > 4

the area under the curve (AUC) numeric rating scale (NRS) at 48 h

cumulative postoperative analgesic consumption within 48 h

Timed Up and Go test

range of motion

length of hospital stays

patient satisfaction

adverse events

Ping Mou 2021

RCT

General anesthesia (post-operation)

ACB + iPACK: ACB (20 ml of 0.25% ropivacaine, 2.0 ug/mL of epinephrine)

iPACK (20 ml of 0.25% ropivacaine, 2.0 ug/mL of epinephrine)

ACB (20 ml of 0.25% ropivacaine, 2.0 ug/mL of epinephrine)

Preoperatively celecoxib 200 mg PO

Postoperatively A cold pack was used to decrease pain; celecoxib (200 mg, PO. twice daily); pregabalin (150 mg, PO. twice daily); Oxycodone hydrochloride tablet (10 mg) was reserved as secondary rescue analgesia

postoperative pain scores

opioid consumption

functional evaluation

postoperative complications

  1. PO Take orally, tid Three times a day, qd Four times a day, bid Twice a day, ACB Ultrasound-guided adductor canal blocks, iPACK ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee