Genicular Nerve Block Versus IPACK Block for Knee Arthroscopic Surgery

Comparison of Efficacy Between Ultra-sound Genicular Nerve Block Versus the Popliteal Artery and the Capsule of the Posterior Knee(IPACK) Block for Knee Arthroscopic Surgery

Postoperative pain management after knee arthroscopic surgery continues to evolve with better treatment strategies being formulated to improve patient satisfaction, and clinical outcomes and reduce opioid use in the immediate postoperative period. appropriate perioperative pain management has been shown to result in faster recovery and rehabilitation leading to better functional outcomes in patients undergoing knee arthroscopic surgery. this has necessitated the development of multimodal analgesics. peripheral nerve blockade has been reported to deliver optimal postoperative pain relief and is increasingly preferred in patients undergoing arthroscopic procedures and various different techniques such as sciatic nerve block, femoral nerve block, and genicular block have been described.

The genicular nerves include branches from the femoral, common peroneal, saphenous, tibial, and obturator nerves which innervate the knee capsule. the superolateral, superomedial, and inferomedial branches of the genicular nerve were reported to be in proximity to the periosteum of the tibia and femur, and the superolateral, inferolateral, superomedial, and inferomedial quadrant of the anterior knee joint were shown to be innervated by superior lateral, inferior lateral, superior medial and inferior medial branches of the genicular nerve, respectively alongside the branches of peroneal and femoral nerves Thus, a genicular nerve block specifically Targets these branches which innervate the knee joint for the management of postoperative pain in arthroscopic surgery.

On the other hand, the interspace between the popliteal artery and capsule of the knee(IPACK) block provides analgesia on the posterior knee joint, and the application of a genicular or IPACK block has been proven to be associated with promising outcomes following arthroscopic surgery

Inclusion Criteria:

• age 20_60 years
• American Society of anthologist class I-III
• BMI18_35 kg/m2
• scheduled for primary unilateral knee arthroscopic surgery

Exclusion Criteria:

• known allergy to local anesthesia
• contraindication to local anesthesia injection (e.g., infection at the site of injection
• contraindication to spinal anesthesia (e.g., coagulopathy)
• patients with preexisting motor or sensory deficit in lower extremities
• insulin or non-insulin-dependent diabetes mellitus
• systemic corticosteroids use within 30 days
• history of arrhythmia or seizures
• severe renal insufficiency
• patient refusal