Comparison of the role of the iPACK Interspace between the Popliteal Artery and the Capsule of the Posterior Knee block versus local infiltration analgesia as part of a multimodal regimen for total knee arthroplasty

Total knee arthroplasty (TKA), or total knee replacement, is a frequently performed surgical procedure associated with significant postoperative pain that has the potential to delay mobilization, reduce patient satisfaction, and contribute to development of chronic pain if inadequately controlled. With an aging population, the expected rise in TKA procedures underscores the need for optimized multimodal analgesia that provides optimal analgesia while facilitating early mobility.

Pain management strategies for TKA include:

1. Neuraxial techniques (e.g. epidural analgesia)

2. Peripheral nerve blocks (e.g. femoral nerve block, adductor canal block [ACB], the iPACK block)

3. Local techniques (e.g. local infiltration analgesia [LIA], intra - articular catheters)

These are typically combined with systemic analgesics to form comprehensive multimodal regimens.

Motor - sparing peripheral techniques - especially ACB and iPACK - are emphasized within Enhanced Recovery After Surgery (ERAS) pathways, as they allow early ambulation with minimal quadriceps impairement. This study looks at three techniques: Local infiltration analgesia (LIA), the adductor canal and the iPACK block.