Role of iPACK ( Infiltration between popletial artery and capsule of knee ) in chronic knee pain.

We will divide patients into two groups -

1. Group I -Patients that will recieve iPACK block for knee pain.

2. Group P -Patients that will recieve placebo (Normal saline).

We will start with baseline work up of the patient.

It will include- Proper history of the patient.

Baseline investigations ( Complete blood counts, Viral markers, Liver function test , Renal function test).

After baseline workup, patient is taken to pain OT. We secure intravenous canula, monitor blood pressure , ECG , and Sp02 during the procedure.

• Group I - For the patient recieving iPACK block, the pt is kept in prone position, a 6-15 MHz high frequency linear transducer is kept at the medial part of knee. The probe was moved from cranial to caudal direction until the two heads of the gastrocnemius muscle were visualized.We then identify the popletial artery. At this plane the stimuplex needle (10 centimetre) is advanced in lateral to medial direction using an in-plane approach until the needle tip was located between the popletial artery and the capsule of knee. The drug is then given in this plane.

We give 10 ml of 0.2 % Ropivacaine with 20 mg Triamcinolone.

• Group P- For the second group, we will give normal saline as a placebo.

We will also observe for any adverse effects and complications during and after the procedure.

We will observe the patient for 2 hours after the procedure, and the patient will be discharged on the same day.

Patient will be given following advice on discharge -

1. Keep cold compression on the knee for 3 hours after the procedure.

2. Avoid brisk walking , increasing load on knee, and performing heavy strenuous exercise of the knee for a week after the procedure.

3. Tell the patient to come for follow up a week after the procedure.

4. Patient will be given aceclofenac + paracetamol tablet as a rescue drug, and will be asked to take the tablet if NRS score is more than 4 at anytime . We will also note how many times the patient took rescue drugs.

The parameters that we will study are -

1. NRS Score .

2. WOMAC Score.

3. Motor weakness.

The parameters will be compared at following time points-

1. Before the procedure.

2. 2 hours after the procedure.

3. 7 days after the procedure.

4. 15 days after the procedure.

5. 30 days after the procedure.