Efficacy Evaluation Of IPACK Block Combined With Adductor Canal Block On Postoperative Analgesia After Total Knee Arthroplasty:A Systematic Review And Meta-analysis

Objective:Meta-analysis was conducted on the existing experimental studies comparing IPACK block combined with adductor canal block and adductor canal block alone for postoperative analgesia after total knee arthroplasty,and the gradeⅠevidence in the literature was systematically reviewed to determine the clinical effectiveness and safety of the two for postoperative pain management after total knee arthroplasty.To explore whether IPACK block can bring additional analgesic benefits to existing multi-mode analgesia.Method:Through computer retrieval of CNKI,Wanfang Database,VIP Chinese Database,Pub Med,Web of Science,Google Scholar,The Cochrane Library,Embase and other databases,according to the experimental keywords,we comprehensively searched and screened the clinical trial studies comparing IPACK block（infiltration between the popliteal artery and the capsule of the posterior knee,IPACK）combined with ACB（adductor canal block,ACB）and ACB alone for postoperative analgesia after total knee arthroplasty.Two reviewers independently conducted literature search,literature screening and data processing,and used Review Manager 5.4 software to conduct quality assessment and meta-analysis of the included experimental studies.The primary outcome measures included pain scores at rest and motor status at 4,8,12,24,and 48 hours after surgery and opioid consumption at 24,24-48 hours after surgery,and until discharge.Secondary outcomes included cumulative walking distance at 24,24-48 hours postoperatively;range of motion at 24,24-48 hours postoperatively and at discharge;the time of first getting out of bed after surgery and length of hospital stay.Results:Sixteen experimental studies were eventually included,with a total of 1640 patients（768 in the IPACK block combined with ACB group and 872 in the ACB group）.The results of Meta-analysis showed that there were statistically significant differences between the two groups in the pain scores of patients in resting state and movement state at 4,8,12,24,and48 hours after surgery（P<0.05）.IPACK block combined with ACB was better than ACB alone.It has better postoperative analgesia effect.IPACK block combined with ACB had better postoperative analgesia effect than ACB alone.There was no significant difference in opioid consumption between the two groups at 24,24-48 hours after operation（P>0.05）.There was a statistically significant difference in opioid consumption between the two groups before discharge（P < 0.05）,and IPACK block combined with ACB was less opioid consumption than ACB alone.There were statistically significant differences in the cumulative walking distance at 24,24-48 hours after operation;joint range of motion at 24,24-48 hours after operation and at discharge;after surgery and length of hospital stay（P<0.05）,IPACK block combined with ACB was superior to ACB alone.Conclusion:In a multimodal analgesia regimen after total knee arthroplasty,IPACK block combined with ACB block is more effective than ACB alone in resting and exercise pain management and reduces postoperative opioid consumption,increased postoperative joint range of motion,shortened after surgery and the length of hospital stay.There was no significant difference in the cumulative walking distance after surgery,and more experimental studies may be needed to explore.