Comparison of the popliteal artery and the capsule of the posterior knee (IPACK) block and the genicular nerve block in primary total knee arthroplasty: A prospective randomized trial

Abdulrahim Dündar; Deniz İpek; Mehmet Yalvaç; Şehmuz Kaya

doi:10.15537/smj.2024.45.3.20230432

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Figure 1
- The study flow diagram highlighting the process of study.
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Figure 2
- Mean and 95% confidence interval plots showing the time-dependent variation of a) TUG, b) MRC, and c) Tramadol, d), repeated measures, Mean and 95% confidence interval plots showing the time-dependent variation of ROM repeated measures. IPACK: interspace between the popliteal artery and the posterior, TUG: time up go test, MRC: Medical Research Council Scale for Muscle Strength, ROM: range of motion
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Figure 3
- Mean and 95% confidence interval graphs showing the time-dependent variation of repeated measures of a) VAS scores at rest and b) movement.

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Table 1

- Statistical results for comparison of demographic and clinical characteristics of patients among research groups.

Factors	Groups			P-values	Post-hoc P-values
Factors	IPACK (n=20)	Genicular (n=20)	Control (n=20)	P-values	Post-hoc P-values
Gender
Male	8 (40%)	9 (45%)	10 (50%)	0.817^{^a}	-
Female	12 (60%)	11 (55%)	10 (50%)	0.817^{^a}	-
ASA
1	2 (10%)	2 (10%)	3 (15%)	0.857^{^b}	-
2	5 (25%)	8 (40%)	6 (30%)
3	13 (65%)	10 (50%)	11 (55%)
Age	65.85±6.87	68.15±6.96	64.35±5.43	0.182^{^c}	-
Body mass index	30.5±2.03	31.95±2.48	31.45±2.8	0.176^{^c}	-
Surgical time (minutes)	60.9±4.34	59.55±4.14	61±3.53	0.450^{^c}	-
KSS score	44±3.98	48.9±5	69.45±10.33	<0.001^{^d}	1-2: 0.004
					1-3: <0.001
					2-3: <0.001
OKS score	23.05±3.8	26.35±5.66	49.15±6.06	<0.001^{^c}	1-2: 0.127
					1-3: <0.001
					2-3: <0.001
WOMAC score	38.4±5.92	41.4±4.74	69.95±7.48	<0.001^{^c}	1-2: 0.279
					1-3: <0.001
					2-3: <0.001

BMI: body mass index, KSS: Knee Society Clinical Rating System, OKS: Oxford Knee Score, WOMAC: Western Ontario, McMaster Universities osteoarthritis index, IPACK: interspace between the popliteal artery and the posterior

↵^a Chi square test with n (%).
↵^b Fisher exact test with n (%).
↵^c One way ANOVA followed by Tukey post-hoc test with mean±standard deviation (SD).
↵^d One way ANOVA followed by Games-Howel post-hoc test with mean±SD.

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Table 2

- Statistical results for the comparison of TUG, MRC, ROM, and Tramadol rescue values among research groups between groups and within groups at different time points.

Factors	Groups			P-values (between)	Post-hoc P-values
Factors	IPACK (n=20)	Genicular (n=20)	Control (n=20)	P-values (between)	Post-hoc P-values
TUG
12 hours	81.10±2.86	82.95±4.46	98.70±5.89	<0.001^{^d}	1-2: 0.277
					1-3: <0.001
					2-3: <0.001
24 hours	45.8±4.22	44.4±5.11	53.65±3.21	<0.001^{^c}	1-2: 0.555
					1-3: <0.001
					2-3: <0.001
P-values (within)	<0.001^{^f}	<0.001^{^f}	<0.001^{^f}
MRC
12 hours	4.85±0.36	4.85±0.36	4.35±0.48	0.001^{^e}	1-2: 1.000
	4.85±0.36	4.85±0.36	4.35±0.48		1-3: 0.002
	5 (4-5)	5 (4-5)	4 (4-5)		1-3: 0.002
	5 (4-5)	5 (4-5)	4 (4-5)		2-3: 0.002
24 hours	5±0	5±0	4.9±0.31	0.131^{^e}	-
24 hours	5 (5-5)	5 (5-5)	5 (4-5)	0.131^{^e}	-
P-values (within)	0.083^{^g}	0.083^{^g}	0.001^{^g}
Tramadol rescue (mg)
0-12 hours	230±65.69	175±55.01	245±51.04	0.001^{^e}	1-2: 0.028
	230±65.69	175±55.01	245±51.04		1-3: 1.000
	200 (100-400)	200 (100-300)	200 (200-300)		1-3: 1.000
	200 (100-400)	200 (100-300)	200 (200-300)		2-3: 0.001
12-24 hours	165±48.93	140±50.26	215±48.93	<0.001^{^e}	1-2: 0.427
	165±48.93	140±50.26	215±48.93		1-3: 0.028
	200 (100-200)	100 (100-200)	200 (100-300)		1-3: 0.028
	200 (100-200)	100 (100-200)	200 (100-300)		2-3: <0.001
P-values (within)	0.004^{^g}	0.052^{^g}	0.034^{^g}
ROM
Pre-op	111.1±5.99	110.2±5.45	111.2±6.63	0.862^{^c}	-
12 hours	33.9±3.81	34.45±3.87	23.65±3.18	<0.001^{^c}	1-2: 0.882
					1-3: <0.001
					2-3: <0.001
24 hours	91.45±4.05	90.35±3.42	90.20±4.09	0.541^{^c}	-
P-values (within)	<0.001^{^h}	<0.001^{^h}	<0.001^{^h}
Post-hoc P-values	1-2: <0.001	1-2: <0.001	1-2: <0.001
	1-3: <0.001	1-3: <0.001	1-3: <0.001
	2-3: <0.001	2-3: <0.001	2-3: <0.001

TUG: time up go test, MRC: Medical Research Council Scale for Muscle Strength, ROM: range of motion, IPACK: IPACK: interspace between the popliteal artery and the posterior

↵^c One way ANOVA followed by Tukey post-hoc test with mean±standard deviation (SD).
↵^d One way ANOVA followed by Games-Howel post-hoc test with mean±SD.
↵^e Kruskal Wallis test followed by Dunn-Bonferroni post-hoc test with median (min-max) and mean±SD.
↵^f Paired t-test with mean±SD.
↵^g Wilcoxon signed rank test with median (min-max) and mean±SD.
↵^h Repeated measures ANOVA followed by Bonferroni post-hoc test with mean±SD.

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Table 3

- Statistical results for the comparison of VAS scores at rest and movement between research groups between groups and within groups at different time points.

Factors	Groups			P-values (between)	Post-hoc P-values
Factors	IPACK (n=20)	Genicular (n=20)	Control (n=20)	P-values (between)	Post-hoc P-values
VAS at rest
Pre-op	4.8±1.05	5.4±1.14	4.95±0.99	0.190^{^c}	-
12 hours	5±1.07	4.95±0.99	7.1±0.91	<0.001^{^c}	1-2: 0.986
					1-3: <0.001
					2-3: <0.001
24 hours	5.75±0.63	4.15±0.58	5.85±0.74	<0.001^{^c}	1-2: <0.001
					1-3: 0.882
					2-3: <0.001
P-values (within)	0.013^{^h}	0.001^{^h}	<0.001^{^h}
Post-hocP-values	1-2: 1.000	1-2: 0.675	1-2: <0.001
	1-3: 0.032	1-3: 0.002	1-3: 0.011
	2-3: 0.073	2-3: 0.017	2-3: 0.004
VAS at movement
Pre-op	7.05±0.88	6.9±1.07	6.8±1.1	0.741^{^c}	-
12 hours	7.3±1.03	6.55±0.94	8.2±1.05	<0.001^{^c}	1-2: 0.058
					1-3: 0.018
					2-3: <0.001
24 hours	7±0.79	5.15±0.67	7.60±0.68	<0.001^{^c}	1-2: <0.001
					1-3: 0.028
					2-3: <0.001
P-values (within)	0.536^{^h}	<0.001^{^h}	<0.001^{^h}
Post-hoc P-values	-	1-2: 0.892	1-2: 0.002
		1-3: <0.001	1-3: 0.058
		2-3: <0.001	2-3: 0.146

VAS: visual analog scale

↵^c One way ANOVA followed by Tukey post-hoc test with mean±standard deviation (SD).
↵^h Repeated measures ANOVA followed by Bonferroni post-hoc test with mean±SD,