Interv Pain Med Neuromod
Interv Pain Med Neuromod

article information

Interventional Pain Medicine and Neuromodulation: Vol.1, issue 1; e115222
published online: July 11, 2021
article type: Letter
received: April 14, 2021
accepted: June 12, 2021
DOI: https://doi.org/10.5812/ipmn.115222
Crossmark

IPACK Block as a Bridge for New Treatment Modalities of Knee Osteoarthritis

authors:

avatar Reza Aminnejad ORCID 1 , 2 , * , avatar Mohammad Reza Aryani 3

Department of Anesthesiology and Pain Medicine, Qom University of Medical Sciences, Qom, Iran
Clinical Research Development Centre, Shahid Beheshti Hospital, Qom, Iran
Aryani Pain Clinic, Tehran, Iran

how to cite: Aminnejad R, Aryani M R. IPACK Block as a Bridge for New Treatment Modalities of Knee Osteoarthritis. Interv Pain Med Neuromod. 2021;1(1):e115222. https://doi.org/10.5812/ipmn.115222.

Dear Editor,

Pain is perceived in chronic pain patients in many counties. However, pain management is known as a core ethical duty in modern medicine (1). Chronic pain is defined as a condition lasting more than three months (2). Knee osteoarthritis is a common chronic pain condition affecting the aging population (3). The higher prevalence of the disease in adults, especially people over 65 years of age, causes a great economic burden (4). Knee osteoarthritis therapies include a wide range of modalities, including conservative and lifestyle changes, and major surgeries such as joint replacement therapies (5). Cell-based therapy is an emerging treatment modality despite the lack of sufficient documents (6). There is no cure or definitive therapy for knee osteoarthritis, and most physicians recommend weight loss and exercise as a basic management strategy (3-5).

A large number of patients with knee osteoarthritis in need of treatment are elderly people who suffer from debilitating pain for a long time. In many cases, these patients do not receive adequate treatment and may not have taken oral medications to control their pain and inflammation for a long time. Performing minimally invasive procedures, such as cell-based therapies, may not be very satisfying for the patients in the short term because these procedures are associated with delayed optimal effects. In such cases, there is a vacancy for a treatment modality that can fill this gap.

The infiltration between the popliteal artery and capsule of the knee (IPACK) block is a new anesthetic method for controlling postoperative pain in major knee surgeries (7). The IPACK block is a better postoperative pain control method than periarticular multimodal drug injection in total knee arthroplasty patients (8). Performing an IPACK block with relatively long-lasting medications such as corticosteroids in chronic knee pain patients in the same session following therapeutic procedures such as intraarticular injection of platelet-rich plasma, or Orthokine can help reduce the patient’s pain until the ideal effect of the performed method takes place. Proving that this method of pain control is effective and finding an ideal drug regimen requires further investigation.

References

  • 1.

    Jukic M, Puljak L. Legal and ethical aspects of pain management. Acta Med Acad. 2018;47(1):18-26. [PubMed ID: 29957968]. https://doi.org/10.5644/ama2006-124.211.

  • 2.

    Dydyk AM, Yarrarapu SNS, Conermann T. Chronic pain. Florida, USA: StatPearls Publishing; 2021.

  • 3.

    Billesberger LM, Fisher KM, Qadri YJ, Boortz-Marx RL. Procedural treatments for knee osteoarthritis: A review of current injectable therapies. Pain Res Manag. 2020;2020:3873098. [PubMed ID: 32148599]. [PubMed Central ID: PMC7049418]. https://doi.org/10.1155/2020/3873098.

  • 4.

    Al-Najar M, Khalil H, Al-Ajlouni J, Al-Antary E, Hamdan M, Rahmeh R, et al. Intra-articular injection of expanded autologous bone marrow mesenchymal cells in moderate and severe knee osteoarthritis is safe: A phase I/II study. J Orthop Surg Res. 2017;12(1):190. [PubMed ID: 29233163]. [PubMed Central ID: PMC5727956]. https://doi.org/10.1186/s13018-017-0689-6.

  • 5.

    Gress K, Charipova K, An D, Hasoon J, Kaye AD, Paladini A, et al. Treatment recommendations for chronic knee osteoarthritis. Best Pract Res Clin Anaesthesiol. 2020;34(3):369-82. [PubMed ID: 33004154]. https://doi.org/10.1016/j.bpa.2020.06.006.

  • 6.

    Vakharia RM, Roche MW, Alcerro JC, Lavernia CJ. The current status of cell-based therapies for primary knee osteoarthritis. Orthop Clin North Am. 2019;50(4):415-23. [PubMed ID: 31466658]. https://doi.org/10.1016/j.ocl.2019.06.001.

  • 7.

    Kandarian B, Indelli PF, Sinha S, Hunter OO, Wang RR, Kim TE, et al. Implementation of the IPACK (infiltration between the popliteal artery and capsule of the knee) block into a multimodal analgesic pathway for total knee replacement. Korean J Anesthesiol. 2019;72(3):238-44. [PubMed ID: 30776878]. [PubMed Central ID: PMC6547229]. https://doi.org/10.4097/kja.d.18.00346.

  • 8.

    Jung DW, Shon WY, Seo SS, Kim OG, Lee IS. Comparison of the postoperative analgesic effect for infiltration between the popliteal artery and the capsule of the posterior knee and that of periarticular multimodal drug injection in total knee arthroplasty: Retrospective study in the immediate postoperative period. Knee Surg Relat Res. 2020;32(1):1. [PubMed ID: 32660618]. [PubMed Central ID: PMC7219207]. https://doi.org/10.1186/s43019-019-0025-z.