iPACK block vs. periarticular injection for total knee arthroplasty. A comprehensive review

Introduction: Total knee arthroplasty (TKA) is commonly performed in patients with end-stage osteoarthritis or rheumatoid arthritis of the knee to reduce joint pain, increase mobility and improve quality of life. However, TKA is associated with moderate to severe postoperative pain, which remains a significant clinical challenge. Surgeon-administered PAI and anesthesiologist-administered iPACK have proven viable alternatives to conventional peripheral nerve blocks. This review aims to discuss which IPACK block or periarticular injection, combined or not with different peripheral nerve blocks, has better effects on postoperative rehabilitation, patient satisfaction, and overall outcome. Material: and Method The literature was reviewed through four electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase. Results: The initial search yielded 494 articles. Fifty-eight relevant articles were selected based on relevance, recentness, search quality, and citations. Six studies compared PAI to peripheral nerve block (PNB), and eight studies checked the effectiveness of adding PNB to PAI. Three studies compared iPACK to PNB, and ten studies checked the effectiveness of adding PNB to iPACK. Conclusions: The best analgesic effect is obtained by combining PAI or iPACK with a peripheral nerve block, particularly with ACB, due to its analgesic and motor-sparing effect, and satisfactory analgesia