ArticleAmerican journal of translational research2026
Effect of iPACK block versus femoral nerve block on postoperative movement pain and muscle strength in patients undergoing total knee replacement.
Article in American journal of translational research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesPostoperative pain and quadriceps weakness hinder rehabilitation following total knee arthroplasty (TKA), creating a dilemma when using motor-blocking femoral nerve blocks (FNB). This study compared the effect of the motor-sparing infiltration popliteal artery-knee capsule (iPACK) block relative to FNB on analgesia and functional recovery.
methodsThis retrospective cohort study analyzed patients undergoing unilateral TKA under spinal anesthesia between June 2022 and October 2025, grouped by received block (iPACK or FNB). Resting and activity pain were assessed at 2, 6, 12, and 24 hours, and 2 weeks postoperatively. Quadriceps strength, range of motion (ROM), straight leg raise, and Timed Up and Go (TUG) test were evaluated on postoperative days 1 and 2. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were collected preoperatively and at 8 weeks.
resultsOf 156 patients, 82 received iPACK and 74 received FNB. The iPACK group showed significantly reduced pain scores across all time points (activity pain at 6 hours: 5.11 vs. 5.93, P=0.003) and reduced 48-hour morphine consumption (18.18 vs. 24.31 mg, P<0.001). The iPACK group also showed superior quadriceps strength (day 2: 3.79 vs. 3.61 kg, P<0.001), ROM (day 2: 100.24° vs. 97.18°, P=0.002), and faster TUG times (day 2: 5.87 vs. 8.33 seconds, P<0.001). At 8 weeks, WOMAC and KSS were significantly better in the iPACK group.
conclusionsFor TKA patients, the iPACK block provides more effective analgesia, superior quadriceps strength preservation, and accelerated functional recovery compared to FNB.
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