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Infiltration Between Popliteal Artery and Capsule of Posterior Knee (iPACK) Block
Daewoong Lee, MD; Nicole Z. Spence, MD; Kimberly Ting, MD
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KEY FACTS

  • Terminology

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Abbreviations

            • Infiltration between popliteal artery and capsule of knee (iPACK) block
          • Synonyms

            • Injection between popliteal artery and capsule of knee block
          • Definitions

            • Nerve blockade of branches of sciatic nerve innervating posterior aspect of popliteal fossa
            • iPACK block targets articular branches of tibial, common peroneal, and obturator nerves in popliteal region
            • Selectively block innervation of posterior knee joint while sparing main trunks of tibial and common peroneal nerves to maintain sensorimotor function of lower leg
            • It is field block not targeting discrete nerve branches
            • iPACK block can be completed at 2 different levels
              • At level of 1 finger breadth above patella
              • At level of femoral condyle

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things To Do

                                • Things To Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      Selected References

                                      1. Gomez M et al:Ultrasound for Regional Anesthesia: iPACK block: advancing the science of ultrasound guided regional anesthesia and pain medicine. http://www.usra.ca/regional-anesthesia/specific-blocks/lower-limb/iPACK.php. Reviewed September 2019. Accessed September 10, 2019.
                                      2. Kampitak W et al: Optimal location of local anesthetic injection into the interspace between the popliteal artery and posterior capsule of the knee (iPACK) for posterior knee pain after total knee arthroplasty: an anatomical and clinical study. Korean J Anesthesiol. 72(5):486-94, 2019
                                      3. Niesen AD et al: Interspace between popliteal artery and posterior capsule of the knee (IPACK) injectate spread: a cadaver study. J Ultrasound Med. 38(3):741-5, 2019
                                      4. Sebastian MP et al: Saphenous nerve and IPACK block. Reg Anesth Pain Med. ePub, 2019
                                      5. Tran J et al: Evaluation of the iPACK block injectate spread: a cadaveric study. Reg Anesth Pain Med. ePub, 2019
                                      6. Kim DH et al: Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg. 129(2):526-35, 2018
                                      7. Sankineani SR et al: Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol. 28(7):1391-5, 2018
                                      8. Soffin EM et al: Anesthesia and analgesia for total knee arthroplasty. Minerva Anestesiol. 84(12):1406-12, 2018
                                      9. Thobhani S et al: Novel regional techniques for total knee arthroplasty promote reduced hospital length of stay: an analysis of 106 patients. Ochsner J. 17(3):233-8, 2017
                                      10. Lages-Silva E et al: Effect of protective and non-protective antibodies in the phagocytosis rate of Trypanosoma cruzi blood forms by mouse peritoneal macrophages. Parasite Immunol. 9(1):21-30, 1987
                                      Related Anatomy
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Procedure

                                          • Post Procedure

                                            • Outcomes

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Infiltration between popliteal artery and capsule of knee (iPACK) block
                                              • Synonyms

                                                • Injection between popliteal artery and capsule of knee block
                                              • Definitions

                                                • Nerve blockade of branches of sciatic nerve innervating posterior aspect of popliteal fossa
                                                • iPACK block targets articular branches of tibial, common peroneal, and obturator nerves in popliteal region
                                                • Selectively block innervation of posterior knee joint while sparing main trunks of tibial and common peroneal nerves to maintain sensorimotor function of lower leg
                                                • It is field block not targeting discrete nerve branches
                                                • iPACK block can be completed at 2 different levels
                                                  • At level of 1 finger breadth above patella
                                                  • At level of femoral condyle

                                              PREPROCEDURE

                                              • Indications

                                                • Contraindications

                                                  • Preprocedure Imaging

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Expected Outcome

                                                                  • Things To Do

                                                                    • Things To Avoid

                                                                      OUTCOMES

                                                                      • Problems

                                                                        • Complications

                                                                          Selected References

                                                                          1. Gomez M et al:Ultrasound for Regional Anesthesia: iPACK block: advancing the science of ultrasound guided regional anesthesia and pain medicine. http://www.usra.ca/regional-anesthesia/specific-blocks/lower-limb/iPACK.php. Reviewed September 2019. Accessed September 10, 2019.
                                                                          2. Kampitak W et al: Optimal location of local anesthetic injection into the interspace between the popliteal artery and posterior capsule of the knee (iPACK) for posterior knee pain after total knee arthroplasty: an anatomical and clinical study. Korean J Anesthesiol. 72(5):486-94, 2019
                                                                          3. Niesen AD et al: Interspace between popliteal artery and posterior capsule of the knee (IPACK) injectate spread: a cadaver study. J Ultrasound Med. 38(3):741-5, 2019
                                                                          4. Sebastian MP et al: Saphenous nerve and IPACK block. Reg Anesth Pain Med. ePub, 2019
                                                                          5. Tran J et al: Evaluation of the iPACK block injectate spread: a cadaveric study. Reg Anesth Pain Med. ePub, 2019
                                                                          6. Kim DH et al: Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg. 129(2):526-35, 2018
                                                                          7. Sankineani SR et al: Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol. 28(7):1391-5, 2018
                                                                          8. Soffin EM et al: Anesthesia and analgesia for total knee arthroplasty. Minerva Anestesiol. 84(12):1406-12, 2018
                                                                          9. Thobhani S et al: Novel regional techniques for total knee arthroplasty promote reduced hospital length of stay: an analysis of 106 patients. Ochsner J. 17(3):233-8, 2017
                                                                          10. Lages-Silva E et al: Effect of protective and non-protective antibodies in the phagocytosis rate of Trypanosoma cruzi blood forms by mouse peritoneal macrophages. Parasite Immunol. 9(1):21-30, 1987