The study is a randomized, prospective, comparative study where 50 patients subjected to knee surgeries were randomized into two groups: Group (A): patients in this group received ultrasound-guided ACB only Group (AB): under ultrasound guide, patients in this group received a combined ACB and IPACK block at the start of surgery. To compare the postoperative range of motion and the analgesic efficacy of adductor canal block (ACB) alone against adductor canal with IPACK (interspace between popliteal artery and capsule of the knee) block in knee surgeries. In this study, the benefit of pure sensory nerve block could be reached. The trend is fast track knee surgery with early ambulation and hospital discharge, so analgesic options of neuraxial blocks and main nerve blocks are less attractive due to the unavoidable muscle weakness. Knee surgeries are needed in a wide range of patients, from young athletes with anterior cruciate ligament injuries up to old patients with comorbidities presenting for arthroscopy up to total knee replacement procedures. Modified excerpt from VH Dissector with permission from Touch of Life Technologies Inc (Built on real anatomy from the National Library of Medicine's Visible Human Project. In (F), the adductors longus (3) and magnus (4, with its tendineous insertion in black) are marked with green and purple, respectively, in (F). Sartorius (1), medial vastus (2), adductor longus (3), adductor magnus (4), pectineus (5), iliopsoas (6), rectus femoris (7) muscles. The midpoint (pink arrow, A–F) between the ASIS (cyan arrows, A–F) and the base of patella (white arrows, A–F) is in the FT in most human beings. The AC is roofed by the VAM (VAM = blue area, B–C). The apex of the FT (blue arrow, A–F) indicates the proximal end of the AC (AC = white area, D–F). The base of the FT (FT = pink area, D–E) is the inguinal ligament (yellow arrows, A–F). The FA (red arrow, A) and femoral vein are the only structures that extend from the base of the FT to the exit of the AC (ie, the adductor hiatus, green arrow, C–F). The figure shows the location of the FT and the AC in a thigh. The nerves are yellow: femoral nerve (A, G) saphenous nerve (green border and arrow, B–F) medial vastus nerve (blue border and arrow, B–F) anterior obturator branch (cyan border and arrow, B–D) posterior obturator branch (red border and arrow, B) AC (pink area and arrow, D–F) VAM (cyan stripe, D–F).
Femoral artery and vein are red and blue profiles, respectively (A–G).
Sartorius (1) medial vastus (2) adductor longus (3) adductor magnus (4) and adductor brevis (5) patella (6) ASIS (7). The levels are as follows: the inguinal crease (A) the apex of the IPF (B) the midpoint between the ASIS and the base of patella (C) the apex of the FT-ie, the proximal end of the AC (D) the midpoint of the VAM (E) the adductor hiatus-ie, the distal end of the AC (F). The figure shows 6 cross sections (A–F) of a thigh (G).
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