The purpose of this article is to evaluate the role of ultrasound-guided adductor tube block combined with popliteal artery and posterior capsule space block in postoperative pain relief after total knee arthroplasty. Retrieve PubMed EMBASE,Web of Science,A randomized controlled trial (RCT) comparing the effects of iPACK combined with ATB on postoperative analgesia in TKA using the Chinese Biomedical Literature Database (CBM), Chinese Science and Technology Journal Full text Database (VIP), Chinese Journal Full text Database (CNKI), and Wanfang Database. The retrieval time is from the establishment of the database to April 2024. Two researchers screened literature and extracted data based on inclusion criteria, while two evaluators independently evaluated the quality of the included literature using RevMan5.3 for meta-analysis. As a result, a total of 442 patients were included in 4 RCTs. Compared with the Control group, the experimental group showed a significant decrease at the resting pain score at 12 h after surgery (MD=-1.13; 95%CI -1.20 ~ -1.06, P<0.00001) , the resting pain score at 24h after surgery (MD=-0.11; 95% CI-0.17~ -0.04, P=0.0001) , the resting pain score at 48h after surgery (MD=-0.09; 95% CI-0.17 ~ -0.02, P=0.01) , the exercise pain score at 12 h after surgery (MD=-1.10; 95%CI -1.17 ~ -1.02, P<0.00001) , the exercise pain score at 24h after surgery (MD=-0.33; 95% CI-0.38 ~ -0.27, P<0.00001), the exercise pain score at 48h after surgery (MD=-0.33; 95% CI-0.39~ -0.27, P<0.00001) , 72h postoperative exercise state pain scores (MD=-0.21; 95%CI -0.42 ~ -0.01, P=0.04) , the number of times the analgesic pump pressed (MD=-1.23; 95% CI-1.33~ -1.13, P<0.00001) , the first time to get out of bed (MD=-11.68; 95% CI-13.35~ -10.02, P<0.00001). Compared with the Control group, the experimental group showed a significant increase at the knee joint range of motion at 24hours after surgery (MD=6.92; 95%CI 3.33 ~ 10.51, P=0.0002), the knee joint range of motion at 48hours after surgery (MD=6.92; 95%CI 3.62 ~ 10.22, P<0.00011). There is no significant difference at 72h postoperative resting state pain scores between the two groups of patients (MD=-0.18; 95%CI -0.38 ~ 0.02, P=0.08), the incidence of nausea and vomiting (RR=0.64, 95% CI 0.30~1.37, P=0.25) , the knee joint range of motion at 72hours after surgery (MD=1.69; 95%CI -1.63 ~ 5.01, P=0.32). Compared to ACB, The combination of iPACK block and ACB can more effectively alleviate postoperative pain after total knee arthroplasty, which is beneficial for patients to get out of bed early and increase knee joint range of motion. It is safe and effective for postoperative analgesia in TKA.

Yang Yan, Shu Peng, Liu Zhenlin. Meta-analysis of the analgesic effect and adverse reactions of ultrasound-guided adductor canal block combined with popliteal artery and posterior capsule space block in patients undergoing total knee arthroplasty. Academic Journal of Medicine & Health Sciences (2024), Vol. 5, Issue 6: 8-17. https://doi.org/10.25236/AJMHS.2024.050602.

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