Effects of adding an ipack block to an adductor canal block on postoperative pain and length of hospital stay in patients undergoing total knee arthroplasty

Objective: Total knee arthroplasty (TKA) is associated with significant postoperative pain, and effective pain control is critical for early mobilization and successful rehabilitation. The aim of this study was to evaluate the effects of adding an interspace between the popliteal artery and the capsule of the knee (IPACK) block to the adductor canal block (ACB) on postoperative pain scores, opioid consumption, functional mobilization, and length of hospital stay. Methods: In this prospective, randomized, double-blind study, 91 patients undergoing unilateral TKA under spinal anesthesia were enrolled.Group A received an ACB with 20 mL of 0.5% bupivacaine, while Group I received an ACB plus an IPACK block using 40 mL of 0.25% bupivacaine. Postoperative pain scores at rest, during 45° knee flexion, and during movement (NRS); total opioid consumption; knee flexion angle; Timed Up and Go (TUG) test; length of hospital stay were recorded. Results: Demographic characteristics were comparable between groups (p>0.05).Total opioid consumption was significantly lower in Group I compared to Group A (20mg vs. 30mg p<0.001).Knee flexion angle was significantly higher in Group I (90° vs. 80°, p<0.001). TUG test times at 24, 48, and 72 hours were significantly shorter in Group I (p<0.001). Length of hospital stay was shorter in Group I (96 hours vs. 108 hours, p=0.001).Early postoperative pain scores at rest, during flexion, and during movement (4th and 8th hours) were significantly lower in Group I (p<0.001). No significant differences were observed in quadriceps muscle strength or Bromage scores. Antiemetic requirement was significantly lower in Group I (p=0.026).