Outcomes following use of IPACK nerve block: A systematic review and meta-analysis of randomized controlled trials

Total Knee Arthroplasty (TKA) is a common procedure, but postoperative pain remains a significant concern. The IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block is used to improve analgesia and reduce opioid consumption when combined with other nerve blocks. This meta-analysis evaluates the efficacy of IPACK in improving pain, opioid use, and functional outcomes after TKA.

A systematic review was conducted per PRISMA guidelines using Ovid Medline and Embase to identify randomized controlled trials (RCTs) evaluating IPACK in TKA. Data collected included visual analogue scale (VAS) pain scores, opioid consumption, timed-up and go (TUG) test, knee range of motion (ROM), and ambulation distance. Random-effects meta-analyses estimated pooled standardized mean differences. Subgroup analyses were performed by IPACK technique and postoperative time point.

Nineteen RCTs including 1702 patients were analyzed. No significant differences in VAS scores were found between experimental and control groups for IPACK + Adductor Canal Block (ACB) or IPACK + sham. Opioid consumption did not differ significantly at early or late postoperative time points. ROM and ambulation distance were significantly greater in the IPACK group overall. TUG test results showed no significant differences.

IPACK does not appear to significantly improve pain control or reduce opioid use following TKA compared to other modalities. However, early postoperative functional outcomes may be enhanced. Further research is needed to refine study designs and clarify the role of IPACK in optimizing recovery after TKA.