Comparison of postoperative analgesic efficacy of adductor canal block, İPACK block, and genicular nerve block under spinal anesthesia in patients total knee arthroplasty

Aim: After total knee arthroplasty (TKA), patients experience severe postoperative pain. This situation reduces patient satisfaction, delays mobility and prolongs hospital stay. Nowadays, peripheral nerve blocks, which are a part of multimodal analgesia, are widely used in postoperative pain management. In this study, adductor canal block (ACB), infiltration block between popliteal artery and knee capsule (IPACK) and genicular nerve block (GNB); effects on postoperative VAS score, opioid consumption and mobility were investigated. Material and method: This study was planned as prospective, randomized, doubleblind. 90 patients planned for primary TKA under spinal anesthesia were included in the study. The patients were divided into three groups (n = 30). ACB (group A), IPACK block (group I) and GNB (group G) were applied to the patients. Peripheral nerve blocks were performed before spinal anesthesia with 15 mL 0.375% bupivacaine. The patients' VAS score, opioid consumption amount and mobilization tests were compared in the postoperative period. Results: The groups were similar in terms of ASA scores and demographic characteristics. VAS scores were statistically significantly lower in group G than in the other two groups at the 4th, 6th and 12th hour (P=0.006, P=0.040, P=0.041, respectively). In the first 12 hours postoperatively, VAS scores were found to be lower in group G than in group A and group I. The total amount of opioids consumed in the first 24 hours after surgery was statistically significantly lower in group G than in the other two groups (P = 0.014). The time it took for patients to complete the three meters walk test was shorter in the GNB group than in the ACB and IPACK block groups, but this difference was not statistically significant. Conclusion: Since genicular nerve block provides a significant decrease in postoperative VAS scores and reduces opioid consumption in TKA, it may be preferred over ABP and IPACK blocks in postoperative analgesia. Key Words: Total knee arthroplasty, adductor canal block, IPACK block, genicular nerve block