Objective To investigate the effect of ultrasound-guided interspace between popliteal artery and capsule of the
posterior knee (IPACK) blocks combined with adductor canal block and sciatic nerve block combined with adductor canal block
in elderly patients undergoing total knee arthroplasty (TKA). Methods This study was a prospective study. The clinical data
of 108 elderly patients undergoing unilateral TKA were included. The patients were randomly divided into two groups: the observation group received IPACK combined with adductor canal block, the control group received sciatic nerve block combined
with adductor canal block, with 54 cases in each group. Outcome measures including: Changes of vital signs, recovery time,
incidence of related adverse reactions; Expression levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), matrix metalloproteinase 3 (MMP3), high sensitivity C-reactive protein (hs-CRP) at 6, 12, 24 h after operation; Numerical rating scale (NRS)
pain score and substance P (SP) at 6, 12, 24 h after operation; Lysholm score and WOMAC score at 48 h after operation were
compared. Results The changes of vital signs in the two groups were compared, the systolic blood pressure (SBP), diastolic
blood pressure (DBP) and heart rate (HR) in the observation group were lower than those in the control group (P<0.05); The
recovery time, recovery time of postoperative spontaneous respiration, and PACU stay time of the observation group were
shorter than those of the control group (P<0.05); The incidence of adverse reactions including nausea, vomiting and hypoxemia
in the observation group were lower than those in the control group (P<0.05); The levels of IL-6, IL-1β, MMP3 and hs-CRP
in the observation group at 6, 12, 24 h after operation were lower than those in the control group (P<0.05); The resting and
exercise NRS pain scores and substance P in the observation group were significantly lower than those in the control group
(P<0.05); The Lysholm scores in the observation group at 48 h after operation were higher than those in the control group,
but the WOMAC scores in the observation group at 48 h after operation were lower than those in the control group (P<0.05).
Conclusion IPACK combined with adductor canal block for elderly patients undergoing TKA surgery has a good analgesic
effect, it can help the patients to reduce their recovery time, maintain the stability of hemodynamics, alleviate inflammatory
response, improve the pain control and reduce the occurrence of adverse reaction, which is better than the sciatic nerve block
combined with adductor canal block.
