全膝关节置换术（total knee arthroplasty, TKA）术后疼痛可能会导致患者功能锻炼延迟、住院时间延长、影响预后恢复等负面结果。临床上多用股神经阻滞（femoral nerve block, FNB）提供膝关节前内侧镇痛，而收肌管阻滞（adductor canal block, ACB）与FNB镇痛效果相似，且可以保留股四头肌的肌力，正逐渐取代FNB。膝关节后方的镇痛可由近年来新提出的腘动脉与膝关节后囊间隙浸润（infiltration of the interspace between popliteal artery and the capsule of posterior knee, IPACK）提供，该技术不影响胫神经和腓神经的运动分支，不降低膝关节以下的肌力，有利于术后镇痛、促进早期功能锻炼与恢复、降低术后黏连，缩短住院时间。目前，国内对于IPACK的研究鲜有报道，文章通过查阅文献，就IPACK的作用机制、实施方法、与其他神经阻滞相复合的临床效果开展综述，以期为TKA的良好镇痛提供理论及实践参考。
Postoperative pain after total knee arthroplasty (TKA) may lead to negative outcomes such as delaying functional exercise, prolonging hospital stays and slow prognostic recovery. Femoral nerve block (FNB) is commonly used in clinic to provide anterior medial pain relief of the knee. The adductor canal block (ACB) also effectively provide anterior knee analgesia with similar effect as femoral nerve block in TKA patients in the condition that retaining quadriceps strength. ACB is gradually replacing FNB. The analgesia behind the knee joint can be provided by the newly proposed infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK). This technique neither affects the motor branches of tibial nerve and peroneal nerve, nor reduces the muscle strength below the knee joint. It is beneficial to improve postoperative analgesia, promote early functional exercise and recovery, reduce postoperative adhesion and shorten hospital stay. At present, there are few reports on IPACK research in China. This review summarizes the literature to dissect the mechanism of IPACK, implementation methods and clinical effects combined with other nerve blocks so as to provide theoretical and practical references for well analgesia of TKA.
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