IPACK Block for Postoperative Pain After ACL Surgery

Overseen By John Miller, MD

Age: Any Age

Sex: Any

Trial Phase: Phase 4

Sponsor: Loyola University

Must not be taking: Opioids

Disqualifiers: Previous knee surgery, Chronic opioid use, others

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 3

Duration: 1 day

78 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a pain management technique called the IPACK block (Infiltration between the popliteal artery and capsule of the posterior knee block) can reduce pain and the need for opioids after ACL (anterior cruciate ligament) surgery. Participants will be divided into two groups: one will receive the IPACK block, and the other will receive a placebo (a look-alike treatment with no active drug). Researchers will compare the pain levels and opioid reliance of each group. This trial is suitable for patients planning ACL surgery with Dr. John Miller at Loyola University Medical Center who have not had previous knee surgeries or infections. As a Phase 4 trial, this research involves an FDA-approved treatment and aims to understand its benefits for more patients, offering a chance to contribute to broader medical knowledge.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you are a chronic opioid user, you cannot participate in the trial.

What is the safety track record for the IPACK block treatment?

Research has shown that the IPACK block is a promising method for relieving pain after knee surgeries. Studies have found that this technique can significantly reduce pain levels and decrease the need for opioids post-surgery. For example, some studies reported that patients experienced less pain and required fewer painkillers like morphine after receiving an IPACK block.

The IPACK block uses a local anesthetic, which numbs a specific area to prevent pain. Patients generally tolerate this well, and side effects are rare, making it a relatively safe option for pain management.

Overall, research considers the IPACK block safe and effective. It can help lessen pain and reduce the use of opioids, which are strong painkillers with potential side effects. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Researchers are excited about the IPACK block for managing postoperative pain after ACL surgery because it offers a targeted approach to pain relief. Unlike traditional systemic pain medications, which affect the whole body, the IPACK block focuses specifically on the nerves around the knee, potentially reducing side effects and improving recovery time. By using ultrasound guidance to inject bupivacaine directly into the area, this method may provide more effective pain control and allow for quicker rehabilitation compared to standard practices. This localized delivery is what sets the IPACK block apart and why it's generating interest in the medical community.

What evidence suggests that the IPACK block is effective for controlling postoperative pain after ACL surgery?

Research has shown that the IPACK block, a type of pain relief method, can effectively reduce pain after knee surgeries. In this trial, participants will receive either the IPACK block or a placebo treatment. Studies have found that patients who received the IPACK block experienced less pain compared to those who did not. These patients also often required fewer opioid painkillers after surgery. The block numbs specific nerves around the knee to lessen pain. This method helps manage discomfort after surgery and may reduce the risk of opioid dependence. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for patients 16 or older who are undergoing ACL reconstruction at Loyola University Medical Center and can make their own medical decisions. It's not for those with chronic opioid use, using cadaver grafts, allergic to local anesthetics, or with past surgery/infections in the knee.

Inclusion Criteria

I am 16 years old or older.

I can make my own medical decisions and agree to join the study.

I am choosing to have ACL surgery with Dr. John Miller at Loyola University.

Exclusion Criteria

I am using a cadaver's tissue for my ACL surgery.

I have had a knee infection before.

I have had surgery on my knee before.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo ACL reconstruction surgery with either an IPACK block or placebo

1 day

1 visit (in-person)

Immediate Post-operative Monitoring

Pain scores and opioid consumption are monitored in the PACU immediately after surgery

2-3 hours

1 visit (in-person)

Follow-up

Participants are monitored for pain scores and opioid use up to one week post-operatively

1 week

1 visit (in-person or phone call)

What Are the Treatments Tested in This Trial?

Interventions

• IPACK
• PLACEBO

Trial Overview The study tests if the IPACK block—anesthetic technique—reduces pain and opioid use after ACL surgery compared to a placebo. Participants are randomly assigned to either receive IPACK or a placebo without knowing which one they get.

How Is the Trial Designed?

Group I: IPACK Experimental Treatment 1 Intervention

After the adductor canal block, the anesthesiologist will reposition, visualize the anatomy of the IPACK block with ultrasound, and place 1% lidocaine for skin infiltration. Once adequate needle visualization is achieved within the correct anatomic position and plane, 20mL of 0.5% bupivacaine will be injected.

Group II: Placebo Placebo Group 1 Intervention

After the adductor canal block, the anesthesiologist will reposition, visualize the anatomy of the IPACK block with ultrasound, and place 1% lidocaine for skin infiltration. Once adequate needle visualization is achieved within the correct anatomic position and plane, 20mL of normal saline will be injected.

Who Is Running the Clinical Trial?

Loyola University

Lead Sponsor

Trials

161

Recruited

31,400+

Published Research Related to This Trial

The iPACK block is an effective method for managing chronic knee joint pain in patients with knee osteoarthritis, demonstrating its potential for pain control.

This technique may also be beneficial in perioperative settings and for other pain-related procedures, such as radiofrequency ablation, by targeting the popliteal plexus.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using the iPACK block to reduce chronic pain in a patient with knee osteoarthritis: A case report. Kim, J., Lee, K., Kim, Y., et al.[2021]

The IPACK block, which targets the area between the popliteal artery and the knee capsule, shows promise as an effective analgesic strategy for knee pain, particularly in surgeries like knee replacement and ACL reconstruction, based on a review of 35 studies.

When used in combination with the adductor canal block (ACB), the IPACK block may enhance pain relief and functional outcomes while reducing the risk of complications like foot drop compared to traditional tibial nerve blocks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Infiltration between the popliteal artery and the capsule of the knee (IPACK) block in knee surgery: a narrative review. Chan, E., Howle, R., Onwochei, D., et al.[2021]

The IPACK technique, used in three adolescent patients undergoing ACL surgery, effectively provided additional pain relief by targeting the area behind the knee, enhancing the effects of a continuous femoral nerve block.

This method resulted in minimal opioid requirements for pain management post-surgery and did not cause any motor weakness in the sciatic nerve, indicating a safe approach for pain control in adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Infiltration Between Popliteal Artery and Capsule of the Knee Block to Augment Continuous Femoral Nerve Catheter for Adolescent Anterior Cruciate Ligament Reconstruction: A Case Series. Nguyen, KT., Marcelino, R., Jagannathan, N., et al.[2021]

In a study of 96 patients undergoing total knee arthroplasty (TKA), adding an interspace between the popliteal artery and capsule of the posterior knee (IPACK) block to an enhanced recovery after surgery (ERAS) pathway did not significantly reduce opioid consumption or improve most functional outcomes.

However, the IPACK block was associated with a significantly lower incidence of posterior knee pain (8.7% in the IPACK group vs. 39% in the control group), suggesting it may help alleviate this specific type of pain after surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Integrating IPACK (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) Block in an Enhanced Recovery after Surgery Pathway for Total Knee Arthroplasty-A Prospective Triple-Blinded Randomized Controlled Trial. Bh, PP., Jinadu, S., Okunlola, O., et al.[2023]

The infiltration between the popliteal artery and capsule of the knee (IPACK) block significantly enhances postoperative pain control for knee surgery, reducing the need for opioid painkillers.

This study presents a straightforward and reproducible technique for administering the IPACK block during arthroscopic procedures, improving patient comfort and recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Surgeon-Directed Arthroscopic Infiltration Between the Popliteal Artery and Capsule of the Knee (IPACK) Block: Technical Description. Shroff, JB., Hanna, P., Edgar, CM.[2023]

The combination of iPACK block and adductor canal block (ACB) significantly reduced opioid consumption in the first 24 hours after total knee arthroplasty (TKA), suggesting a more effective pain management strategy.

While the iPACK block + ACB group showed lower Visual Analogue Scale (VAS) scores for pain at rest and during activity on the day of surgery, these differences did not reach the minimal clinically important difference, indicating that while beneficial, the combination may not lead to substantial improvements in pain perception.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does the Addition of iPACK Block to Adductor Canal Block Provide Improved Analgesic Effect in Total Knee Arthroplasty? A Systematic Review and Meta-Analysis. Wang, JH., Ma, HH., Chou, TA., et al.[2023]

The iPACK block significantly reduced postoperative pain scores during activity at 4 hours after total knee arthroplasty compared to periarticular local infiltration analgesia (LIA), indicating its effectiveness for immediate pain control.

Patients receiving the iPACK block demonstrated faster physical rehabilitation, as shown by quicker performance in the timed up and go test, while both techniques did not differ in knee range of motion.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block versus periarticular local infiltration analgesia after unilateral total knee arthroplasty: Prospective randomized control trial. Narejo, AS., Abdulwahab, F., Aqil, M., et al.[2022]

The implementation of the IPACK block in total knee arthroplasty patients significantly reduced the lowest pain scores on postoperative day 0 compared to patients who did not receive the block, indicating its efficacy in pain management.

Despite the improvement in pain scores, other outcomes such as opioid consumption, ambulation distance, and length of stay remained unchanged, suggesting that while IPACK blocks can enhance early pain relief, they do not affect overall recovery metrics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement. Kandarian, B., Indelli, PF., Sinha, S., et al.[2020]

In a study of 89 patients undergoing unilateral primary total knee arthroplasty, the addition of the IPACK block to standard adductor canal block (ACB) and periarticular injection (PAI) did not significantly reduce postoperative pain compared to ACB and PAI alone.

There were no differences in opioid usage or ambulation pain between the two groups, suggesting that the IPACK block may not provide additional benefits for pain management in this surgical context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of adding an interspace block to the posterior knee for perioperative pain in total knee arthroplasty: a randomized controlled trial. Chatmaitri, S., Tangwiwat, S., Halilamien, P., et al.[2022]

In a cadaveric study involving 14 specimens, both proximal and distal ultrasound-guided iPACK injection techniques achieved similar areas of dye spread in the popliteal region, indicating effective targeting of posterior knee pain after total knee arthroplasty.

The proximal injection technique resulted in greater anteromedial dye spread, while the distal technique showed more anterolateral spread, suggesting that the choice of injection technique can influence the distribution of analgesic effects in the knee.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of the iPACK block injectate spread: a cadaveric study. Tran, J., Giron Arango, L., Peng, P., et al.[2019]

Citations

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Outcomes following use of IPACK Nerve Block The IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block is used to improve analgesia and reduce opioid consumption ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6547229/

Implementation of the IPACK (Infiltration between ... The Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block is a new anesthesiologist- administered analgesic technique for controlling ...

3. tandfonline.com tandfonline.com/doi/full/10.1080/11101849.2023.2246732

Effect of Adding Infiltration between The Popliteal Artery ... Our study found that the use of continuous ultrasound guided adductor canal block and the Infiltration between the popliteal artery and capsule of the knee ...

4. journals.sagepub.com journals.sagepub.com/doi/full/10.1177/2325967125S00269

Efficacy of Surgeon Directed Arthroscopic IPACK Block ... The purpose of this study is to investigate the effect of this practice on the post operative pain control as well as identify any adverse ...

5. josr-online.biomedcentral.com josr-online.biomedcentral.com/articles/10.1186/s13018-025-05605-6

A novel technique of intraoperative infiltration between ... Interspace infiltration between the posterior knee capsule and popliteal artery (iPACK) is an effective method for pain control following total ...

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Infiltration between the popliteal artery and the capsule of ... The infiltration between the popliteal artery and the capsule of the knee (IPACK) block has been described as an alternative analgesic strategy for knee pain.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9627073/

IPACK (Interspace between the Popliteal Artery and the ... Our study confirmed that with the addition of IPACK, SACB could significantly reduce the pain scores, morphine consumption, as well as to improve functional ...

8. josr-online.biomedcentral.com josr-online.biomedcentral.com/articles/10.1186/s13018-022-03272-5

iPACK block (local anesthetic infiltration of the interspace ... The addition of iPACK lowers postoperative VAS scores, cumulative morphine consumption, and hospital stays. Meanwhile, the addition of iPACK improves ...

9. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0883540323000104

Addition of Infiltration Between the Popliteal Artery and ... This randomized controlled trial demonstrated that there were significantly lower pain scores, less opioid consumption, and better functional results with LIA ...

10. researchgate.net researchgate.net/publication/359529661_IPACK_Infiltration_between_the_Popliteal_Artery_and_the_Capsule_of_the_Knee_and_Adductor_Canal_Block_ACB_versus_Periarticular_Injection_PAI_Enhances_Postoperative_Pain_Control_in_Anterior_cruciate_lig/download

(PDF) IPACK (Infiltration between the Popliteal Artery and ... 037). CONCLUSIONS: The addition of iPACK and ACB significantly improves analgesia and reduces opioid consumption after ACL repair compared to PAI alone. This ...