The IPACK block was offered to reduce pain, opioid consumption and facilitate early rehabilitation and discharge. These 2 patients were selected as they were under the care of the same surgeon and anesthetist. We describe our experience with the proximal approach of the IPACK block for ACLR. We aim to block the popliteal plexus, saphenous nerve and nerve to vastus medialis with a single injection by redirecting the needle after a single puncture. The transducer is then slid caudally to trace the artery as it dives into the popliteal fossa through the adductor hiatus to become the popliteal artery. In the supine position, the transducer is placed in the medial lower third aspect of the thigh to observe the femoral artery under the sartorius muscle. The IPACK block has evolved from being performed in a prone position where the injection occurs at the popliteal crease at the level of the femoral condyles, to being done with the patient supine. This leads to earlier ambulation, rehabilitation and recovery in various knee surgeries. The technique involves a very selective block of the terminal sensory branches of the posterior aspect of the knee without the involvement of motor branches of the tibial and peroneal nerves leading to reduced pain without motor weakness. The recent technique of ultrasound guided local anesthetic infiltration of the interspace between the popliteal artery and the capsule of posterior knee (IPACK) has shown promising results. Given the multiple innervations of the knee, complete pain relief would not be expected from either the femoral nerve block (FNB) or the saphenous nerve block alone.
There are various choices of PNBs available either as a single injection or in combination. A multimodal analgesia regime with peripheral nerve blocks (PNB) is therefore recommended for this procedure. Anterior cruciate ligament reconstruction (ACLR) surgery is associated with moderate to severe postoperative pain which can be attributed to both arthroscopic surgery and the graft donor site.
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