The analgesic efficacy of iPACK after knee surgery: A systematic review and meta-analysis with trial sequential analysis.

Détails

ID Serval
serval:BIB_CE49ABA5774D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
The analgesic efficacy of iPACK after knee surgery: A systematic review and meta-analysis with trial sequential analysis.
Périodique
Journal of clinical anesthesia
Auteur(s)
Albrecht E., Wegrzyn J., Dabetic A., El-Boghdadly K.
ISSN
1873-4529 (Electronic)
ISSN-L
0952-8180
Statut éditorial
Publié
Date de publication
09/2021
Peer-reviewed
Oui
Volume
72
Pages
110305
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
The novel infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to relieve posterior knee pain after knee surgery. The study objective is to determine whether iPACK provides analgesia after knee surgery when compared with a control group.
Systematic review, meta-analysis and trial sequential analysis.
Operating room, postoperative recovery area and ward, up to 24 postoperative hours.
Patients scheduled for knee surgery under general or spinal anaesthesia.
We searched five electronic databases for randomized controlled trials comparing iPACK with a control group.
The primary outcome was rest pain score scores on a visual analogue scale (VAS) of 0-10 at 12 h postoperatively, analysed according to the nature of surgery (total knee arthroplasty vs. anterior cruciate ligament reconstruction) and the use of multimodal analgesia. Secondary outcomes included rest and dynamic pain scores, intravenous morphine-equivalent consumption at 2 h and 24 h, and functional outcomes including ambulation distance and range of motion at discharge.
Six trials involving 687 patients were included, all of which received total knee arthroplasty only. When compared with a control group, iPACK significantly reduced rest pain scores at 12 h, with a mean difference (95% CI) of -1.0 (-1.5 to -0.5), I <sup>2</sup> = 93%, p = 0.0003, without subgroup differences for postoperative multimodal analgesia (p = 0.15). Secondary pain outcomes were inconsistently improved with iPACK. Functional outcomes were either similar between groups or had clinically unimportant differences. The overall quality of evidence was moderate.
There is moderate level evidence that iPACK might provide analgesia for posterior pain after total knee arthroplasty when compared with a control group at 12 h, but was not associated with any other meaningful benefits. Based on these results, there is currently limited evidence supporting the use of iPACK as a complement to adductor canal block for analgesia after total knee arthroplasty.
Mots-clé
Anesthesiology and Pain Medicine, Analgesia, Knee arthroplasty, Peripheral nerve block, Postoperative pain
Pubmed
Web of science
Open Access
Oui
Création de la notice
14/05/2021 19:03
Dernière modification de la notice
19/06/2021 6:33
Données d'usage