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Evaluation of the iPACK block injectate spread: a cadaveric study
John Tran1, Laura Giron Arango2, Philip Peng3
1Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Regional Anesthesia and Pain Medicine
|May 8, 2019
Summary
Both proximal and distal interspace between the popliteal artery and capsule of the knee (iPACK) block techniques spread dye similarly. Proximal injections favored anteromedial spread, while distal injections favored anterolateral spread, affecting key nerves for posterior knee pain relief.
Area of Science:
- Anatomy and regional anesthesia
- Knee joint innervation
- Ultrasound-guided procedures
Background:
- The interspace between the popliteal artery and capsule of the knee (iPACK) block is a novel regional analgesia technique.
- It targets articular branches for posterior knee pain relief after total knee arthroplasty.
- The precise injectate spread and nerve involvement remain unclear.
Purpose of the Study:
- To compare dye spread area and articular branch staining frequency between proximal and distal iPACK injection techniques.
- To elucidate the anatomical distribution of injectate in the popliteal region.
- To inform optimal iPACK block technique for posterior knee analgesia.
Main Methods:
- Ultrasound-guided iPACK injection of methylene blue dye (10 mL) in 14 cadaveric specimens.
- Seven specimens received proximal injections; seven received distal injections.
- Detailed dissection, digitization, and 3D modeling were used to map dye spread and nerve staining.
Main Results:
- Both proximal and distal iPACK techniques yielded comparable mean injectate spread areas.
- The genicular branch of the posterior obturator nerve was consistently stained.
- Proximal injections led to superior medial genicular nerve staining; distal injections stained superior lateral genicular and common fibular nerves.
Conclusions:
- Both iPACK techniques demonstrate similar injectate spread in the popliteal region and extensive articular branch staining.
- Proximal injections show greater anteromedial spread, while distal injections exhibit more anterolateral spread.
- Further clinical research is needed to validate these cadaveric findings for clinical application.
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