Archive November 2018 XIX, No. 11

What's New in Regional Anesthesia

A quick update on a few exciting developments - and news of a couple setbacks.

Jared Bilski


Pamela Bevelhymer, RN, BSN, CNOR
GETTING CLOSER Advancements in ultrasound mean peripheral nerve blocks can be done further from the spinal cord and closer to where the surgery is being performed.

Just a short note to catch you up on the latest developments in regional anesthesia. Good news first.

1. Motor-sparing blocking. It’s called an IPACK block, short for interspace between the popliteal artery and capsule of the posterior knee block. Anesthesiologist David Kim, MD, of the Hospital for Special Surgery in New York City, recently studied whether combining a periarticular injection with an IPACK block and an adductor canal block would lower pain during ambulation on post-op day 1 more than just the periarticular injection alone.

The trial included 86 patients undergoing unilateral total knee arthroplasty, 43 of whom just received a periarticular injection and 43 of whom received the injection plus the 2 blocks. Not only did those who received the injection with the blocks report significantly lower pain scores than those who only received the periarticular injection, but also they were more satisfied with their care and needed fewer opioids.

“Remember the goal is to reduce pain and increase mobility,” says Dr. Kim. “You want to get patients up and moving as quickly as possible, on the same day whenever you can. Motor-sparing blocks are the key to this.”

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