This procedure will not affect the extra-articular nerve branches to the anterolateral portion of the knee from the common peroneal nerve, the nerves to vastus intermedius and lateralis, and the lateral femoral cutaneous nerve. The posterior group supplies intra-articular innervation to the menisci, the peri-meniscular joint capsule, the cruciate ligaments, the infra-patellar fat pad, and the posterior part of the fibrous knee capsule.(3) The medial para-patellar arthrotomy performed for total knee arthroplasty, through the anteromedial integument of the knee and the extra-articular medial retinacular complex, evokes pain mediated by the infra-patellar branch of the saphenous nerve, the medial retinacular nerve (the terminal branch of the nerve to vastus medialis), and the anterior branch of the medial femoral cutaneous nerve. The popliteal nerve plexus is derived from the tibial nerve and the posterior branch of the obturator nerve. The posterior group consists of the popliteal nerve plexus that ramifies around the genicular vasculature in the popliteal fossa. The lateral femoral cutaneous nerve, the common peroneal nerve, and the nerves to vastus intermedius and lateralis innervate the knee anterolaterally. The anterior-medial compartmental innervation consists of branches from the femoral nerve, including the saphenous nerve, the medial femoral cutaneous nerve and the nerve to vastus medialis. (2) The anatomy of sensory supply to the knee joint is complex with contributions from both the lumbar and sacral plexuses. This can have both detrimental physical and psychological consequences for patients, as well as a substantial economic impact due to increased costs of health care and lost productivity. Untreated pain can result in complex pathophysiology than the pain caused by the original injury or disease. Research has found that orthopedic surgeries are the most painful procedures.(1) Unrelieved pain post orthopedic surgery is a stressor that can cause altered physiologic changes and negative effects on every organ system of the body. Procedure: iPACK Procedure: Periarticular local infiltration analgesia (LIA)īackground: Total Knee Arthroplasty (TKA) is one of the most frequent procedures performed by orthopedic surgeons. Condition or diseaseĪrthroplasty Complications Pain, Joint Arthritis Knee Regional Anesthesia Morbidity Our hypothesis is iPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee) peripheral nerves anesthetic block is superior to Periarticular local Infiltration Analgesia (LIA)which is commonly given by the surgeons during the TKA in terms of pain relief and early mobilization. The ideal analgesic regimen post TKA should enable adequate pain control, early mobilization and physical therapy, shorten hospital stay, reduce the risk of postoperative complications and improve patient satisfaction. Although various analgesic techniques have been proposed, there is currently no consensus on the optimal protocol to improve functional outcomes following TKA. Total knee arthroplasty (TKA) is a common orthopedic procedure associated with severe postoperative pain which may limit patient rehabilitation and hospital discharge.
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