{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T21:32:20Z","timestamp":1785879140429,"version":"3.56.0"},"reference-count":67,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2021,4,29]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The infiltration between the popliteal artery and the capsule of the knee (IPACK) block has been described as an alternative analgesic strategy for knee pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Our aim was to perform a narrative review to examine the place and value that the IPACK block has in comparison to and in conjunction with other regional anesthesia modalities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Evidence review<\/jats:title>\n                  <jats:p>Following an extensive search of electronic databases, we included anatomical studies, letters, comparative observational studies, and non-randomized and randomized controlled trials that examined the IPACK block in relation to surgery on the knee under general or neuraxial anesthesia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>In all, 35 articles were included. Cadaveric studies demonstrated the potential for injected dye to spread to the nerves responsible for the innervation of the posterior as well as anteromedial and anterolateral aspects of the knee. Of the comparative observational studies (n=15) and non-randomized (n=1) and randomized controlled trials (n=13), 2 and 27 were conducted in the context of anterior cruciate ligament reconstruction and knee replacement surgery, respectively. The role of the IPACK block with each different permutation of regional anesthesia techniques was investigated by a small number of studies. Clinical studies, in the setting of knee replacement surgery, revealed variation in the manner in which the IPACK block was performed, and indicated the possible superiority of distal injection at the level of the femoral condyles for the management of posterior knee pain. Evidence suggested the following: the IPACK block in combination with single shot adductor canal block (ACB) may be beneficial for analgesic and functional outcomes; in conjunction with single shot or continuous ACB, the IPACK block might be superior to local infiltration analgesia (LIA); and functional outcomes may be improved with the supplementation of continuous ACB and LIA with the IPACK block. The IPACK block did not commonly result in the occurrence of foot drop. Relative to tibial nerve block (TNB), the IPACK block reduced the occurrence of foot drop and increased the proportion of patients who were able to be discharged on the third postoperative day.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The IPACK block was potentially complementary to the ACB and might be preferable to the TNB as a motor-sparing regional anesthesia technique in knee surgery. Definitive recommendations were not reached in the presence of the heterogeneous and limited evidence base.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2021-102681","type":"journal-article","created":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T11:17:41Z","timestamp":1620991061000},"page":"784-805","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Infiltration between the popliteal artery and the capsule of the knee (IPACK) block in knee surgery: a narrative review"],"prefix":"10.1136","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8917-0556","authenticated-orcid":false,"given":"Edmund","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6172-2101","authenticated-orcid":false,"given":"Ryan","family":"Howle","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, St Vincent's University Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7676-9375","authenticated-orcid":false,"given":"Desire","family":"Onwochei","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK"},{"name":"Honorary Senior Clinical Lecturer, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-9407","authenticated-orcid":false,"given":"Neel","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK"},{"name":"Honorary Senior Clinical Lecturer, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,14]]},"reference":[{"key":"2025101110152087000_46.9.784.1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31828866b3"},{"key":"2025101110152087000_46.9.784.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-013-2750-2"},{"key":"2025101110152087000_46.9.784.3","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000119"},{"key":"2025101110152087000_46.9.784.4","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000673"},{"key":"2025101110152087000_46.9.784.5","doi-asserted-by":"crossref","DOI":"10.1038\/srep40721","article-title":"Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials","volume":"7","author":"Wang","year":"2017","journal-title":"Sci Rep"},{"key":"2025101110152087000_46.9.784.6","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000406"},{"key":"2025101110152087000_46.9.784.7","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-016-0613-2"},{"key":"2025101110152087000_46.9.784.8","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1111\/anae.13568","article-title":"The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta-analysis","volume":"71","author":"Grape","year":"2016","journal-title":"Anaesthesia"},{"key":"2025101110152087000_46.9.784.9","unstructured":"Sinha S , Abras J , Sivasenthil D . Use of ultrasound guided popliteal fossa infiltration to control pain after total knee arthroplasty: a prospective randomized observer-blinded study. ASRA 37th Annual Regional Anesthesia Meeting and Workshops; March 15\u201318, San Diego, CA, 2012."},{"key":"2025101110152087000_46.9.784.10","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"2025101110152087000_46.9.784.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"2025101110152087000_46.9.784.12","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025101110152087000_46.9.784.13","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1002\/jum.14761","article-title":"Interspace between popliteal artery and posterior capsule of the knee (IPACK) injectate spread: a cadaver study","volume":"38","author":"Niesen","year":"2019","journal-title":"J Ultrasound 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technique for total knee arthroplasty","volume":"48","author":"Caballero-Lozada","year":"2020","journal-title":"Colomb J Anesthesiol"},{"key":"2025101110152087000_46.9.784.18","first-page":"5","article-title":"Adductor canal block duration of analgesia successfully prolonged with perineural dexmedetomidine and dexamethasone in addition to IPACK block for total knee arthroplasty","volume":"12","author":"Herman","year":"2020","journal-title":"Cureus"},{"key":"2025101110152087000_46.9.784.19","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jclinane.2019.08.021","article-title":"Ambulatory knee replacements with IPACK block","volume":"60","author":"Jinadu","year":"2020","journal-title":"J Clin Anesth"},{"key":"2025101110152087000_46.9.784.20","article-title":"The combination of adductor canal block and IPACK (interspace between popliteal artery and capsule of posterior knee) in total knee replacement surgery: a pilot study","volume":"43","author":"Gkliatis","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"2025101110152087000_46.9.784.21","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1007\/s00590-018-2218-7","article-title":"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","volume":"28","author":"Sankineani","year":"2018","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2025101110152087000_46.9.784.22","doi-asserted-by":"crossref","first-page":"238","DOI":"10.4097\/kja.d.18.00346","article-title":"Implementation of the IPACK (infiltration between the popliteal artery and capsule of the knee) block into a multimodal analgesic pathway for total knee replacement","volume":"72","author":"Kandarian","year":"2019","journal-title":"Korean J 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with IPACK (interspace between the popliteal artery and the capsule of the posterior knee) block vs periarticular injection for analgesia after total knee arthroplasty: a randomized noninferiority trial","volume":"36","author":"Kertkiatkachorn","year":"2021","journal-title":"J Arthroplasty"},{"key":"2025101110152087000_46.9.784.30","first-page":"A14","article-title":"IPACK block associated with similar length of stay and opioid consumption in total knee arthroplasty","volume":"68","author":"Jensen","year":"2020","journal-title":"J Investig Med"},{"key":"2025101110152087000_46.9.784.31","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinane.2020.109857","article-title":"Community hospital implementation of the IPACK block reduces opioid use and length of stay after total knee arthroplasty","volume":"65","author":"VanderWielen","year":"2020","journal-title":"J Clin 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Perioperative surgical home and the total knee arthroplasty patient: improving care and reducing costs. ASRA 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting; March 31\u2013April 2, New Orleans, LA, 2016:545\u20136."},{"key":"2025101110152087000_46.9.784.36","article-title":"Combination of regional anaesthesia (rA) and local infiltration analgesia (LIA) provide superior analgesia in enhanced recovery hip and knee arthroplasty without delaying postoperative mobilisation","volume":"41","author":"Bhatti","year":"2016","journal-title":"Reg Anesth Pain Med"},{"key":"2025101110152087000_46.9.784.37","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.2106\/JBJS.16.01266","article-title":"Ultrasound-Guided Motor-Sparing knee blocks for postoperative analgesia following total knee arthroplasty: a randomized blinded study","volume":"99","author":"Sogbein","year":"2017","journal-title":"J Bone Joint Surg Am"},{"key":"2025101110152087000_46.9.784.38","article-title":"Peripheral nerve blockade (PNB) results in safe and effective analgesia inday case unicompartmental knee arthroplasty (UKA)","volume":"44","author":"Bhatti","year":"2019","journal-title":"Reg Anesth Pain Med"},{"key":"2025101110152087000_46.9.784.39","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1213\/ANE.0000000000003794","article-title":"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","volume":"129","author":"Kim","year":"2019","journal-title":"Anesth Analg"},{"key":"2025101110152087000_46.9.784.40","unstructured":"Myers TJ , Elliott CE , Patterson ME . The adductor canal block combined with IPACK improves physical therapy performance and reduces Hospital length of stay. 40th Annual Regional Anesthesiology Acute Pain Medicine Meet ASRA, 2015."},{"key":"2025101110152087000_46.9.784.41","first-page":"233","article-title":"Novel regional techniques for total knee arthroplasty promote reduced Hospital length of stay: an analysis of 106 patients","volume":"17","author":"Thobhani","year":"2017","journal-title":"Ochsner J"},{"key":"2025101110152087000_46.9.784.42","unstructured":"Vitter J , Nossaman B , Patterson M . IPACK significantly reduces opioid requirements and ambulatory surgery center length of stay following anterior cruciate ligament repair.. ASRA 42nd Annual Regional Anesthesiology Acute Pain Medicine Meet, San Francisco, California, 2017."},{"key":"2025101110152087000_46.9.784.43","article-title":"The optimal block for total knee arthroplasty \u2013 are we there yet?","volume":"44","author":"Sell","year":"2019","journal-title":"Reg Anesth Pain Med"},{"key":"2025101110152087000_46.9.784.44","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1007\/s12630-020-01652-1","article-title":"The safety and efficacy of the IPACK block in primary total knee arthroplasty: a retrospective chart review","volume":"67","author":"Biehl","year":"2020","journal-title":"Can J Anaesth"},{"key":"2025101110152087000_46.9.784.45","article-title":"Peripheral nerve blocks provide better postoperative pain relief without affecting mobilisation than local infiltration analgesia in enhanced recovery knee arthroplasty","volume":"44","author":"Bhatti","year":"2019","journal-title":"Reg Anesth Pain 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Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership","volume":"34","author":"Hannon","year":"2019","journal-title":"J Arthroplasty"},{"key":"2025101110152087000_46.9.784.62","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/anae.15067","article-title":"Using postoperative pain trajectories to define the role of regional analgesia in personalised pain medicine","volume":"76","author":"Mariano","year":"2021","journal-title":"Anaesthesia"},{"key":"2025101110152087000_46.9.784.63","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/ACO.0000000000000651","article-title":"Rebound pain after regional anesthesia in the ambulatory patient","volume":"31","author":"Lavand'homme","year":"2018","journal-title":"Curr Opin Anaesthesiol"},{"key":"2025101110152087000_46.9.784.64","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/ACO.0000000000000928","article-title":"Peripheral nerve blockade and novel analgesic modalities 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Does the addition of iPACK to adductor canal block in the presence or absence of periarticular local anesthetic infiltration improve analgesic and functional outcomes following total knee arthroplasty? A systematic review and meta-analysis. Reg Anesth Pain Med 2021.","DOI":"10.1136\/rapm-2021-102705"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2021-102681","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:15:34Z","timestamp":1760202934000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2021-102681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,14]]},"references-count":67,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,8,19]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/rapm-2021-102681"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2021-102681","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,14]]}}}