PDF(Pubmed)
Abstract：
Background and Objectives: The interspace between the popliteal artery and the posterior capsule of the knee (iPACK) block has been widely used in perioperative settings to control posterior knee pain and can additionally be used for chronic knee pain. In this cadaveric study, we aimed to investigate the needle tip position and its proximity to the articular branch of the tibial nerve (ABTN) during an iPACK-targeted radiofrequency procedure. Materials and Methods: An ultrasound-guided iPACK block was performed on 20 knees of 10 cadavers. We injected 0.1 mL each of blue and green gelatinous dye near the tibial artery (point A) and posterior knee capsule (point B), respectively, and evaluated the spread of both around the ABTN. For a hypothetical conventional radiofrequency ablation (RFA) lesion (diameter, 2.95 mm) and cooled RFA lesion (diameter, 4.9 mm), we counted the number of specimens in which the ABTNs would be captured. Results: The percentage of specimens in which the ABTN would be captured by a cooled RFA lesion was 64.71% at point A and 43.75% at point B (p = 0.334). Meanwhile, the percentage of specimens in which the ABTN would be captured by a conventional RFA lesion was 58.82% from point A and 25% from point B (p = 0.065). Conclusions: When performing an RFA-based iPACK block, the needle tip may be positioned either lateral to the tibial artery or in the space between the posterior knee capsule and the tibial artery. However, more studies with larger samples are needed to verify these results before the clinical use of this procedure can be recommended.
摘要：
背景和目的：pop动脉和膝关节后囊之间的间隙（iPACK）阻滞已广泛用于围手术期设置，以控制膝关节后疼痛，还可用于慢性膝关节疼痛。在这个尸体研究中,我们旨在研究iPACK靶向射频手术中针尖位置及其与胫神经关节支(ABTN)的接近程度.材料和方法：对10具尸体的20个膝盖进行了超声引导的iPACK阻滞。我们在胫骨动脉（A点）和膝关节后囊（B点）附近注射了0.1mL蓝色和绿色凝胶状染料，分别,并评估了两者在ABTN周围的传播。对于假设的常规射频消融（RFA）损伤（直径，2.95mm）和冷却的RFA病变（直径，4.9mm),我们计算了将捕获ABTNs的标本数量.结果：ABTN被冷却的RFA损伤捕获的样本百分比在A点为64.71％，在B点为43.75％（p=0.334）。同时,ABTN被常规RFA损伤捕获的样本百分比为A点的58.82%和B点的25%(p=0.065).结论：在执行基于RFA的iPACK块时，例如,针尖可以定位在胫骨动脉的外侧或定位在膝关节后囊和胫骨动脉之间的空间中。然而,在建议临床使用该程序之前，需要更多样本的研究来验证这些结果。
