A Study To Compare Ultrasound Guided Modified 4 In 1 Block With Combined Adductor Canal And Injection Between Popliteal Artery And Capsule Of The Knee (IPACK) For Postoperative Analgesia In Total Knee Arthroplasty- A Prospective Randomized Controlled Trial

Introduction -TKA has ensured a better quality of life for geriatric population apropos of eliminating pain, early mobilization and discharge with a better rehabilitation. It is a painful surgery and scarce management of post-operative pain may prolong the hospital stay with increased risk of adverse effects. We compared a modified 4 in 1 block with combined ACB + IPACK for postoperative analgesia after TKA.
Materials and method—The present randomized trial was conducted on patients between the ages 45 and 75 of either sex belonging to ASA I, II, and III who were posted for TKA under SAB.
Results - Non-Parametric tests were used as data were not normally distributed. Wilcoxon-Mann-Whitney Test was used to compare the two groups at each of the timepoints. The Friedman test was used to examine the changes in parameters over time within each group. The Generalized Estimating Equations method was employed to assess the differences in parameter changes between the two groups over time. The two groups showed significant differences in terms of VAS. at: 8, 16, 24, 36 hours after surgery. Hence Group A patients had better pain relief when compared with Group B (p=<0.001). There was a significant difference in the QMST at 36 Hours(W = 700.000, p = 0.036), with patients in Group A having better range of motion. Majority (80%) of the patients had no pain. Ten patients required single dose of Inj. PCM 500mg IV, out of which six belong to Group B.
Conclusion- ACB + IPACK and modified 4 in 1 block are effective in pain management of TKA patients. The combination of ACB + IPACK provides an excellent analgesia, prompt rehabilitation, and early ambulation of the patients. The modified 4 in 1 still needs to prove its efficacy in varied surgeries and in large population sample.