Abstract
<jats:p>INTRODUCTION: Damage to the ligamentous apparatus of the knee joint is a common sports injury in orthopedics. Given the possibility of ambulatory treatment for these patients, perioperative analgesia plays a key role in the success of surgery. OBJECTIVE: To evaluate the effect of adding the iPACK block (infiltration in the interspace between popliteal artery and capsule of the knee) on perioperative analgesia as part of combined anesthesia for arthroscopic cruciate ligament reconstruction (ACLR). MATERIALS AND METHODS: A single-center prospective cohort study with a historical control group. 115 patients who underwent ACLR, were divided into 2 groups: Group 0 (control; n = 58: general anesthesia (GA) + adductor canal block (ACB) + local infiltration anesthesia (LIA), Group 1 (intervention group; n = 57: GA + ACB + LIA + iPACK block). Evaluated: pain intensity on a visual-analog scale (VAS), time to the first requirement of an analgesic, need for opioids, time of verticalization, frequency of rebound pain. RESULTS: Significant differences in pain dynamics were revealed both at rest (χ2 = 17.68; p = 0.013) and in movement (χ2 = 22.68; p = 0.0019) according to VAS among the comparison groups, with a lower score in group 1. The average time to the first analgesic requirement was the longest in the iPACK group. The probability of prescribing trimeperidine in the first 24 hours was significantly lower in the iPACK group (RR 0.112; 95% CI 0.023–0.549; p = 0.007). The average time until verticalization did not differ significantly between the groups. The frequency of rebound pain was 13,5 % in the control and 1.6 % in the iPACK group (RR 0.116; 95% CI 0.013–1.064; p = 0.057). CONCLUSIONS: the addition of the iPACK block to method of combined anesthesia of GA + ACB + LIA significantly reduced the intensity of pain, increased the time to the first requirement for an analgesic, and significantly reduced the need for opioid analgesics in patients undergoing ACLR, demonstrating a favorable safety profile.</jats:p>