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A New Nerve Block for Posterior Knee Pain
The "iPACK" controls pain in the back of the knee after arthroplasty.
T
he problem spot for
patients having total
knee arthroplasty: the
back of the knee. While region-
al nerve blocks have revolution-
ized pain control for total
knees, until recently they've
fallen short when it comes to
easing pain in the back of the
knee.
Pain relief following knee
replacement surgery has typi-
cally been concentrated in the
anteromedial aspects of the
knee, with little relief for the
posterior. Femoral nerve blocks cover the femoral nerve and
adductor canal blocks cover the saphenous nerve. Blocking the
sciatic nerve, which is what provides innervation to the posterior
of the knee, is dangerous, because it may cause foot drop and
thus mask a surgically induced peroneal nerve injury caused dur-
ing surgery. Thankfully, a new regional technique with a catchy
name has proven to effectively control posterior knee pain.
Posterior pain
I augment each of my blocks with an "iPACK" (infiltration between
popliteal artery and capsule of knee) block and have seen a signifi-
cant reduction in post-op posterior pain.
Anesthesia Alert
Mike MacKinnon, CRNA
• PROBLEM SPOT Mr. MacKinnon places an "iPACK" block, which can
decrease posterior knee pain without masking a peroneal nerve injury.
Kirt
Rosenlof,
CRNA
